Late-life depression is associated with an increased risk for all-cause dementia.

Posted on May 11, 2013 by Maurice Preter MD
  • Review article

Late-life depression and risk of vascular dementia and Alzheimer’s disease: systematic review and meta-analysis of community-based cohort studies

  1. Breno S. Diniz,
  2. Meryl A. Butters,
  3. Steven M. Albert,
  4. Mary Amanda Dew and
  5. Charles F. Reynolds 3rd

+ Author Affiliations


  1. Breno S. Diniz, MD, PhD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, USA, and Department of Mental Health, School of Medicine, Federal University of Minas Gerais, Brazil; Meryl A. Butters, PhD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, USA; Steven M. Albert, PhD, Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, USA; Mary Amanda Dew, PhD, Charles F. Reynolds 3rd, MD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, USA
  1. Correspondence: Meryl A. Butters, PhD, Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara Street, Pittsburgh, PA 15213, USA. Email: ButtersMA@upmc.edu

  • Declaration of interest

    In the past 3 years B.S.D. has received payment for lectures from Novartis and had travel/meeting expenses covered by Pfizer. M.A.B. received remuneration for neuropsychological assessment services on a fee-for-service basis, for clinical trials conducted by Northstar Neuroscience and Medtronic and from Fox Learning Systems for developing computerised neuropsychological tasks for an NIH-funded study. The following pharmaceutical companies provide pharmaceutical supplies for C.F.R.’s NIH-sponsored work: Bristol-Myers Squibb, Forrest Laboratories, Lilly and Pfizer.

Abstract

Background

Late-life depression may increase the risk of incident dementia, in particular of Alzheimer’s disease and vascular dementia.

Aims

To conduct a systematic review and meta-analysis to evaluate the risk of incident all-cause dementia, Alzheimer’s disease and vascular dementia in individuals with late-life depression in population-based prospective studies.

Method

A total of 23 studies were included in the meta-analysis. We used the generic inverse variance method with a random-effects model to calculate the pooled risk of dementia, Alzheimer’s disease and vascular dementia in older adults with late-life depression.

Results

Late-life depression was associated with a significant risk of all-cause dementia (1.85, 95% CI 1.67-2.04, P<0.001), Alzheimer’s disease (1.65, 95% CI 1.42-1.92, P<0.001) and vascular dementia (2.52, 95% CI 1.77-3.59, P<0.001). Subgroup analysis, based on five studies, showed that the risk of vascular dementia was significantly higher than for Alzheimer’s disease (P = 0.03).

Conclusions

Late-life depression is associated with an increased risk for all-cause dementia, vascular dementia and Alzheimer’s disease. The present results suggest that it will be valuable to design clinical trials to investigate the effect of late-life depression prevention on risk of dementia, in particular vascular dementia and Alzheimer’s disease.

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Adults with depression and who take specific anti-depressants more likely to develop C. difficile

Posted on May 11, 2013 by Maurice Preter MD

Interesting applied psychoimmunology study. Apparently depressed people’s guts don’t watch direct-to-consumer chemical-imbalance ads. Here is the abstract.

Depression, antidepressant medications, and risk of Clostridium difficile infection

Mary A M Rogers1*, M Todd Greene1, Vincent B Young1, Sanjay Saint1,2, Kenneth M Langa1,2, John Y Kao1 and David M Aronoff1

Author Affiliations

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BMC Medicine 2013, 11:121 doi:10.1186/1741-7015-11-121

Published: 7 May 2013

 

Abstract

Background

An ancillary finding in previous research has suggested that the use of antidepressant medications increases the risk of developing Clostridium difficile infection (CDI). Our objective was to evaluate whether depression or the use of anti-depressants altered the risk of developing CDI, using two distinct datasets and study designs.

Methods

In Study 1, we conducted a longitudinal investigation of a nationally representative sample of older Americans (n = 16,781), linking data from biennial interviews to physician and emergency department visits, stays in hospital and skilled nursing facilities, home health visits, and other outpatient visits. In Study 2, we completed a clinical investigation of hospitalized adults who were tested for C. difficile (n = 4047), with cases testing positive and controls testing negative. Antidepressant medication use prior to testing was ascertained.

Results

The population-based rate of CDI in older Americans was 282.9/100,000 person-years (95% confidence interval (CI)) 226.3 to 339.5) for individuals with depression and 197.1/100,000 person-years for those without depression (95% CI 168.0 to 226.1). The odds of CDI were 36% greater in persons with major depression (95% CI 1.06 to 1.74), 35% greater in individuals with depressive disorders (95% CI 1.05 to 1.73), 54% greater in those who were widowed (95% CI 1.21 to 1.95), and 25% lower in adults who did not live alone (95% CI 0.62 to 0.92). Self-reports of feeling sad or having emotional, nervous or psychiatric problems at baseline were also associated with the later development of CDI. Use of certain antidepressant medications during hospitalization was associated with altered risk of CDI.

Conclusions

Adults with depression and who take specific anti-depressants seem to be more likely to develop CDI. Older adults who are widowed or who live alone are also at greater risk of CDI.

Keywords:

Clostridium difficile; Colitis; Depression; Antidepressant medication

 

Posted in Affective Neuroscience, Aging, dietary, epigenetics, Fifth Avenue Concierge Medicine, Forensic Neuropsychiatry, Health, keto, Psychiatry/Neurology | Tagged , , , , , , |

Neuroprotective properties of magnesium infusion during carotid endarterectomy, and beyond?

Posted on April 20, 2013 by Maurice Preter MD
Went to a masterful talk by E. Sander Connolly at the Lenox Hill Hospital neurology conference last week. This is one of many interesting take-away points. Differential blood-brain barrier penetration by the various statins is another one – currently looking into how this impacts clinical decision making. MP
J Neurosurg. Author manuscript; available in PMC 2009 July 1.
Published in final edited form as:
PMCID: PMC2684565
NIHMSID: NIHMS101036

Intraoperative magnesium infusion during carotid endarterectomy: a double-blind placebo-controlled trial

William J. Mack, M.D.,1 Christopher P. Kellner, B.A.,1 Daniel H. Sahlein, M.D.,4 Andrew F. Ducruet, M.D.,1 Grace H. Kim, M.D.,1 J Mocco, M.D.,1 Joseph Zurica, B.A.,2,3 Ricardo J. Komotar, M.D.,1 Raqeeb Haque, M.D.,1 Robert Sciacca, Eng.Sc.D.,1 Donald O. Quest, M.D.,1 Robert A. Solomon, M.D.,1 E. Sander Connolly, Jr., M.D.,1,3 and Eric J. Heyer, M.D., Ph.D.2,3
The publisher’s final edited version of this article is available at J Neurosurg
See other articles in PMC that cite the published article.

Abstract

Object

Recent data from both experimental and clinical studies have supported the use of intravenous magnesium as a potential therapy in the setting of cerebral ischemia. This study assessed whether intraoperative magnesium therapy improves neuropsychometric testing (NPT) following carotid endarterectomy (CEA).

Methods

One hundred eight patients undergoing CEA were randomly assigned to receive placebo infusion or 1 of 3 magnesium-dosing protocols. Neuropsychometric testing was performed 1 day after surgery and compared with baseline performance. Assessment was also performed on a set of 35 patients concurrently undergoing lumbar laminectomy to serve as a control group for NPT. A forward stepwise logistic regression analysis was performed to evaluate the impact of magnesium therapy on NPT. A subgroup analysis was then performed, analyzing the impact of each intraoperative dose on NPT.

Results

Patients treated with intravenous magnesium infusion demonstrated less postoperative neurocognitive impairment than those treated with placebo (OR 0.27, 95% CI 0.10–0.74, p = 0.01). When stratified according to dosing bolus and intraoperative magnesium level, those who were treated with low-dose magnesium had less cognitive decline than those treated with placebo (OR 0.09, 95% CI 0.02-0.50, p < 0.01). Those in the high-dose magnesium group demonstrated no difference from the placebo-treated group.

Conclusions

Low-dose intraoperative magnesium therapy protects against neurocognitive decline following CEA.

Keywords: carotid endarterectomy, magnesium, neuroprotectant, stroke
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A memory of China – neuropsychiatric consultations at Songjiang Hospital/ Jiao-Tong University in Shanghai 2010

Posted on March 12, 2013 by Maurice Preter MD

In 2010, I was privileged to be invited to participate as a visiting consultant in a full-day medical consultation at Songjiang Hospital, a beautiful, modern university medical center affiliated with Jiao-Tong University and First People’s Hospital in Shanghai.
The story was published in the local newspaper.

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Scourge of depression sees rising number of suicides, report Cang Wei and Song Wenwei in Nanjing.

Posted on February 28, 2013 by Maurice Preter MD

Staggering base rate…

Dark days of despair drive many to the final option
Updated: 2013-02-27 09:20
By Cang Wei and Song Wenwei in Nanjing/China Daily

Scourge of depression sees rising number of suicides, report Cang Wei and Song Wenwei in Nanjing. Every three minutes, a person suffering from depression commits suicide in China and a further 11 people attempt to take their own lives.Every year in China, 287,000 people end their lives by suicide, while another 2 million contemplate the act, 70 percent of them because of depression.

via Dark days of despair drive many to the final option[1]|chinadaily.com.cn.

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