Depression in type 1 diabetes and risk of dementia

Paola Gilsanz et al. | Depression in type 1 diabetes and risk of dementia | Aging & Mental Health | Volume 23:7, p880-886

Objective: Depression afflicts 14% of individuals with type 1 diabetes (T1D). Depression is a robust risk factor for dementia but it is unknown if this holds true for individuals with T1D, who recently started living to an age conferring dementia risk. We examined if depression is a dementia risk factor among elderly individuals with T1D.

Methods: 3,742 individuals with T1D aged over 50 were followed for dementia from 1/1/96-9/30/2015. Depression, dementia, and comorbidities were abstracted from electronic medical records. Cox proportional hazard models estimated the association between depression and dementia adjusting for demographics, glycosylated hemoglobin, severe dysglycemic epidsodes, stroke, heart disease, nephropathy, and end stage renal disease. The cumulative incidence of dementia by depression was estimated conditional on survival dementia-free to age 55.

Results: Five percent (N = 182) were diagnosed with dementia and 20% had baseline depression. Depression was associated with a 72% increase in dementia (fully adjusted HR = 1.72; 95% CI:1.12-2.65). The 25-year cumulative incidence of dementia was more than double for those with versus without depression (27% vs. 12%).

Conclusions: For people with T1D, depression significantly increases dementia risk. Given the pervasiveness of depression in T1D, this has major implications for successful aging in this population recently living to old age.

Teaching happiness to dementia caregivers reduces their depression, anxiety

Moskowitz, J. T  et al. | Randomized controlled trial of a facilitated online positive emotion regulation intervention for dementia caregivers | Health Psychology, 2019 | Vol. 38 (5): p391 – 402

Caring for family members with dementia causes significant emotional and physical stress that increases caregivers’ risk of depression, anxiety and death. A new method of coping with that stress by teaching people how to focus on positive emotions reduced their anxiety and depression after six weeks. It also resulted in better self-reported physical health and positive attitudes toward caregiving.

The intervention included teaching participants eight skills that increase positive emotions. The skills taught were:

1. Recognizing a positive event each day

2. Savoring that positive event and logging it in a journal or telling someone about it

3. Starting a daily gratitude journal

4. Listing a personal strength each day and noting how you used this strength recently

5. Setting an attainable goal each day and noting your progress

6. Reporting a relatively minor stressor each day, then listing ways in which the event can be positively reappraised or reframed

7. Understanding small acts of kindness can have a big impact on positive emotion and practicing a small act of kindness each day

8. Practicing mindfulness through paying attention to daily experiences and with a daily 10-minute breathing exercise, concentrating on the breath

Full story at ScienceDaily 

Full abstract at Health Psychology

Psychosocial risk factors and Alzheimer’s disease

New study predicts that sleep disturbance, depression, and anxiety increase the hazard of Alzheimer’s disease | Aging & Mental Health

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Objectives: Alzheimer’s disease (AD) dementia is a neurodegenerative condition, which leads to impairments in memory. This study predicted that sleep disturbance, depression, and anxiety increase the hazard of AD, independently and as comorbid conditions.

Methods: Data from the National Alzheimer’s Coordinating Center was used to analyze evaluations of 12,083 cognitively asymptomatic participants. Survival analysis was used to explore the longitudinal effect of depression, sleep disturbance, and anxiety as predictors of AD. The comorbid risk posed by depression in the last two years coupled with sleep disturbance, lifetime depression and sleep disturbance, clinician-verified depression and sleep disturbance, sleep disturbance and anxiety, depression in the last two years and anxiety, lifetime depression and anxiety, and clinician-verified depression and anxiety were also analyzed as predictors of AD through main effects and additive models.

Results: Main effects models demonstrated a strong hazard of AD development for those reporting depression, sleep disturbance, and anxiety as independent symptoms. The additive effect remained significant among comorbid presentations.

Conclusion: Findings suggest that sleep disturbance, depression, and anxiety are associated with AD development among cognitively asymptomatic participants. Decreasing the threat posed by psychological symptoms may be one avenue for possibly delaying onset of AD.

Full reference: Burke, S. L. et al. |  Psychosocial risk factors and Alzheimer’s disease: the associative effect of depression, sleep disturbance, and anxiety | Aging & Mental Health | 2018 Vol. 22, issue 12 | p 1577-1584 |  DOI: 10.1080/13607863.2017.1387760

Antidepressants do not help treat depression in people living with dementia

Dudas R, Malouf R, McCleery J and Dening T. Antidepressants for treating depression in dementia. Cochrane Database Syst Rev. 2018;(8):CD003944.

Antidepressants do not reduce symptoms of depression in people with dementia compared with placebo (dummy pills). Measured 6 to 13 weeks after starting the treatment, there is little or no difference in participants’ symptoms, but an increased chance of unwanted side effects. The review did not identify enough data to determine if antidepressants have an effect in the longer-term.

This Cochrane review included randomised controlled trials of any antidepressant drugs compared to placebo. Participants were aged 75 years on average, with mild or moderate dementia. The quality of the included trials was mixed, with not enough information reported to fully assess the risk of bias, though the main result is reliable.

This review supports the NICE guideline, which recommends that antidepressants are not routinely offered to people with dementia and depression, but that psychological treatments are considered instead.

Caregivers’ resilience in mild and moderate Alzheimer’s disease

Rachel Dias Lopes da Rosa, et al. |  Caregivers’ resilience in mild and moderate Alzheimer’s disease | Aging & Mental Health | published online: 30 Nov 2018

Objectives: To investigate the resilience of caregivers of people with mild and moderate Alzheimer’s disease (PwAD) and the related sociodemographic and clinical characteristics.

Methods: Cross-sectional assessment of dyads of PwAD and family caregivers (N = 106). Caregivers were assessed for resilience, depression, anxiety, hopelessness, quality of life, burden and cognition. PwAD were assessed for severity of dementia, cognition, neuropsychiatric symptoms, functionality, quality of life and awareness of disease.

Results: Most of the caregivers (51.1%) reported emotional problems (symptoms of anxiety, stress and depression). In both mild and moderate PwAD groups, resilience was inversely related to self-reported emotional problems. There was not a significant difference between caregivers of mild and moderate PwAD resilience.

Upon analyzing the factors related to resilience, the study found some differences between the groups of caregivers of mild and moderate PwAD. Neuropsychiatric symptoms of PwAD and caregiver’s depressive symptoms were related to resilience of caregivers of mild PwAD. In the moderate group, caregivers’ higher levels of quality of life and co-residing with PwAD were related to resilience.

Conclusion: Caregivers’ resilience is driven by different factors according to disease severity. The findings suggest that resilience allows caregivers to manage and respond positively to stressful demands of care.

Psychosocial interventions for people with dementia and anxiety or depression

Review finds psychosocial interventions to be effective at reducing symptoms of depression or anxiety in people with dementia experiencing these symptoms | Aging & Mental Health

Abstract walking-69708_1280
Objectives:
Assess the effectiveness of psychosocial interventions for depression and anxiety in people with dementia (PWD) or mild cognitive impairment (MCI).

Method:
OvidMedline, PsychInfo and Embase were searched for studies on the 5th August 2017. The efficacy of the studies was estimated using meta-analyses.

 

Results:
Eight RCTs were included. No RCTs were identified for people with MCI. Four RCTs found that psychosocial interventions (multicomponent intervention, Tai Chi, problem adaptation therapy and exercise/walking) were effective at reducing symptoms of depression in PWD who were depressed. One study (Tai Chi) found that these reductions were no longer evident at six-month follow-up. Another study, not included in the meta-analyses, found that pleasant events behaviour therapy and problem solving behaviour therapy improved depression symptoms and this effect remained significant at follow-up. Three RCTs found that psychosocial interventions (music therapy and cognitive behavioural therapy (CBT)) reduced symptoms of anxiety in PWD who were anxious. Evidence from two of these RCTs (music therapy and CBT) showed that these improvements were evident at three to six-month follow-up.

Conclusion:
The identified psychosocial interventions are effective at reducing symptoms of depression or anxiety in PWD experiencing these symptoms. This review is limited by the quality of studies, small sample sizes and the heterogeneity of the interventions, therefore high quality studies with larger sample sizes are required to test the efficacy of specific interventions such as CBT.

Full reference:  Noone, D. et al. | Meta-analysis of psychosocial interventions for people with dementia and anxiety or depressionAging & Mental Health | published online 17 Oct 2018

Antidepressants for treating depression in dementia

Dudas,  R., Malouf,  R., McCleery,  J., & Dening,  T.| 2018|  Antidepressants for treating depression in dementia| Cochrane Database of Systematic Reviews 2018 | Issue 8| Art. No.: CD003944|  DOI: 10.1002/14651858.CD003944.pub2.

A new review from Cochrane looks at the efficacy of antidepressants in treating depression in dementia. This study updates an earlier version, first published in 2002. 

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Plain language summary

Antidepressants for treating depression in dementia

Review question

We reviewed the evidence about the effect of antidepressants on depression in people with dementia.

Background

Depression can be hard to recognise in people with dementia, but there is evidence that it is common and associated with increased disability, poorer quality of life, and shorter life expectancy. Many people with dementia are prescribed antidepressants to treat depression, but there is uncertainty about how effective this is.

Study characteristics

We found ten studies with 1592 people to include in the review. On average, the studies lasted only 12 weeks, although one study ran for nine months. Each of them used a set of formal criteria to diagnose both depression and dementia and compared an antidepressant against a dummy pill (placebo).

The older studies used more old‐fashioned antidepressants (imipramine, clomipramine, and moclobemide) and the newer studies used more modern ones, such as venlafaxine, mirtazapine and so‐called SSRI antidepressants (sertraline, fluoxetine, citalopram and escitalopram).

The people taking part in the studies had an average age of 75 and they had mild or moderate dementia. With the exception of two studies, they were being treated as outpatients.

Key results

We found that there was little or no difference in scores on depression rating scales between people treated with antidepressants and those treated with placebo for 12 weeks. The evidence to support this finding was of high quality, which suggests that further research is unlikely to find a different result. There was probably also little or no difference after six to nine months of treatment.

Another way to assess the effect of antidepressants is to count the number of people in the antidepressant and placebo groups who show significant clinical improvement (response) or who recover from depression (remission). There was low‐quality evidence on the number of people showing a significant clinical improvement and the result was imprecise so we were unable to be sure of any effect on this measure. People taking an antidepressant were probably more likely to recover from depression than were those taking placebo (antidepressant: 40%, placebo: 21.7%). There was moderate‐quality evidence for this finding, so it is possible that further research could find a different result.

We found that antidepressants did not affect the ability to manage daily activities and probably had little or no effect on a test of cognitive function (which includes attention, memory, and language).

People taking an antidepressant were probably more likely to drop out of treatment and to have at least one unwanted side effect.

Quality of the evidence

The quality of the evidence varied, mainly due to poorly conducted studies and problems with the relevance of the outcome measures used. This should be taken into consideration when interpreting the different results on depression rating scales and recovery rates, as evidence was of a higher quality for the former than for the latter.

Another major problem is that side effects are very rarely well‐reported in studies.

Therefore, further research will still be useful to reach conclusions that are more reliable and can better help doctors and patients to know what works for whom.

The full paper is available from the Cochrane 

A summary including the abstract and  plain language summary is here