Junhong Yu

Sleep correlates of depression and anxiety in an elderly Asian population

Research looking at the association between sleep and psychiatric symptoms in elderly Asian populations is lacking. The present study examines the sleep correlates of depression and anxiety in a sample of cognitively healthy older adults.

Poor sleep quality is observed in mild cognitive impairment and is largely unrelated to depression and anxiety

ABSTRACT Background: Individuals with mild cognitive impairment (MCI) commonly experience a number of sleep quality related issues. However, it remains unclear if these issues are specific to MCI or are simply attributed to the elevated levels depression and anxiety symptoms frequently observed among those with MCI. The present study sought to examine group differences between participants with MCI and matched controls on self-reported measures of sleep quality while controlling for depression and anxiety levels. Methods: Participants with MCI (N = 48) and demographically matched controls (N = 48) were administered with self-reported measures of anxiety, depression and sleep quality. Sleep quality between both groups were first analyzed using a Multivariate Analysis of Variance, and then subsequently a Multivariate Analysis of Covariance incorporating depression and anxiety scores as covariates. Results: The MCI group had significantly higher levels of depression and anxiety than the controls. On the sleep-related measures, the MCI group had significantly worse outcomes in sleep duration, disturbances, latency, efficiency, quality and daytime dysfunction. After controlling for depression and anxiety levels, with the exception of daytime dysfunction, all other differences remain significant, and are also associated with moderate to large effect sizes. Conclusion: The results suggest that sleep quality issues are present in MCI and are largely independent of depression and anxiety.

White matter microstructural abnormalities in amnestic mild cognitive impairment: A meta-analysis of whole-brain and ROI-based studies

HighlightsROI‐based meta‐analysis revealed robust white matter alterations in aMCI.Alterations were in the fornix, uncinate fasciculus and parahippocampal cingulum.Alterations in MD, relative to FA, may better characterize aMCI.White matter alterations have significant implications for aMCI research. Abstract Studies that examined white matter (WM) alterations in amnestic mild cognitive impairment (aMCI) abound. This timely meta‐analysis aims to synthesize the results of these studies. Seventy‐seven studies (total NaMCI = 1844) were included. Fourteen region‐of‐interest‐based (ROI‐based) (k ≥ 8; NaMCI ≥ 284 per ROI) and two activation likelihood estimation (ALE) meta‐analyses (fractional anisotropy [FA]: k = 15; NaMCI = 463; mean diffusivity [MD]: k = 8; NaMCI = 193) were carried out. Among the many significant ROI‐related findings, reliable FA and MD alterations in the fornix, uncinate fasciculus, and parahippocampal cingulum were observed in aMCI. Larger effects were observed in MD relative to FA. The ALE meta‐analysis revealed a significant FA decrease among aMCI subjects in the posterior corona radiata. These results provide robust evidence of the presence of WM abnormalities in aMCI. Our findings also highlight the importance of carrying out both ROI‐based and whole‐brain‐based research to obtain a complete picture of WM microstructural alterations associated with the condition.

Depressive symptoms moderate the relationship between sleep quality and cognitive functions among the elderly

ABSTRACT Objective: The co-occurrence of sleep problems, cognitive impairment, and depression among the elderly suggests that these three conditions are likely to be interrelated. Recent findings suggest that depressive symptoms moderate the relationship between sleep problems and cognitive impairment in elderly people but methodological problems have led to inconsistent conclusions. The present study aims to better understand the relationship between sleep quality, depressive symptoms, and cognitive function. Method: We administered the Repeatable Battery for the Assessment of Neuropsychological Status and self-report measures of sleep quality and depression to 380 elderly participants (Mage = 68 years, SD= 5.7). Bootstrapped moderation analyses were conducted to examine the role of depressive symptoms in the relationship between sleep and various aspects of cognitive function. Results: This moderation effect was significant in the domains of delayed memory (ΔR2 = .01, F = 4.5, p = .04), language (ΔR2 = .01, F = 4.6, p = .035), and general cognitive status (ΔR2 = .01, F = 5.3, p = .02). However, unlike previous studies, higher sleep quality corresponded to better outcomes in delayed memory, language abilities, and general cognitive status in participants with low levels of depressive symptoms. No significant relationship between sleep quality and any cognitive function was observed among participants with high levels of depressive symptoms. Conclusions: Among individuals who reported low levels of depressive symptoms, sleep quality was positively related to cognitive performance in the domains of delayed recall, language, and general cognitive status. However, sleep quality was not significantly associated with cognitive abilities in these domains among participants with elevated levels of depressive symptoms; participants had relatively poor outcomes in these cognitive domains regardless of their sleep quality.

The optimal short version of the Zarit Burden Interview for dementia caregivers: diagnostic utility and externally validated cutoffs

ABSTRACT Objectives: Using a sample of dementia caregivers, we compared the diagnostic utility of the various short versions of the Zarit Burden Interview (ZBI) with the original scale to identify the most optimal one. Next, we established externally validated cutoffs for the various ZBI versions using probable depression cases as a reference standard. Methods: Caregivers (N = 394; 236 males; Agemean = 56 years) were administered the ZBI and a self-report depression measure. Participants who exceeded the cutoff for the latter were identified as probable depression cases. For each of the ZBI versions, a receiver operating characteristic (ROC) curve was plotted against probable depression cases. The area under these ROC curves between the short versions and the original were then compared using a non-parametric approach. Results: Compared to the original ZBI, the AUROC were similar for the 6-item, 7-item, and two 12-item versions, but significantly worse for the other short variants. The sensitivity and specificity of the cutoffs for all ZBI versions ranged from 77.3% to 85.2% and 60.1% to 79.8%, respectively. Conclusions: The original ZBI had good utility in identifying probable depression in caregivers, while the 6-item variant can be a useful alternative when short versions are preferred.

Perceived loneliness and general cognitive status in community-dwelling older adults: the moderating influence of depression

ABSTRACT The relationship between depression, loneliness, and cognitive functioning among the elderly is not well understood in the literature. In the present study, we tested the moderating influence of depressive symptoms on loneliness and cognitive functioning. We recruited 100 community-dwelling older adults in Hong Kong. Demographic information, perceived loneliness, depressed mood, and general cognitive status were assessed. Results indicated that married participants reported lower levels of perceived loneliness (t (96) = 2.26, p = .03). We found a significant moderating effect of depressive symptoms on the relationship between perceived loneliness and general cognitive status (B = −.05, p = .002). Perceived loneliness correlated negatively with general cognitive status only in participants with higher levels of depressed mood (B = −.16, p = .01). Together, these findings suggest that perceived loneliness combined with depressed mood is related to poorer general cognitive status in older adults. The implications of these findings are discussed.

Better working memory and motor inhibition in children who delayed gratification

Background: Despite the extensive research on delayed gratification over the past few decades, the neurocognitive processes that subserve delayed gratification remains unclear. As an exploratory step in studying these processes, the present study aims to describe the executive function profiles of children who were successful at delaying gratification and those who were not. Methods: A total of 138 kindergarten students (65 males, 73 females; Mage = 44 months, SD = 3.5; age range = 37–53 months) were administered a delayed gratification task, a 1-back test, a Day/night Stroop test and a Go/no-go test. The outcome measures of these tests were then analyzed between groups using a Multivariate Analysis of Variance, and subsequently a Multivariate Analysis of Covariance incorporating age as a covariate. Results: Children who were successful in delaying gratification were significantly older and had significantly better outcomes in the 1-back test and go/no-go test. With the exception of the number of hits in the go/no-go test, all other group differences remained significant after controlling for age. Conclusion: Children who were successful in delaying gratification showed better working memory and motor inhibition relative to those who failed the delayed gratification task. The implications of these findings are discussed.

Six-month longitudinal associations between cognitive functioning and distress among the community-based elderly in Hong Kong: A cross-lagged panel analysis

Although previous studies have extensively documented the cross-sectional relationship between cognitive impairment and psychological distress, findings relating to their longitudinal associations remains mixed. The present study examines the longitudinal associations and mutual influence between cognitive functioning and psychological distress across six months among community-dwelling elderly in Hong Kong. A total of 162 older adults (40 males; Mage = 69.8 years, SD = 6.4) were administered objective and subjective measures of cognitive functioning, as well as self-reported ratings of distress, at two time points six months apart. Using structural equation modeling, we tested the cross-lagged relationships between cognitive functioning and distress. Our cross-lagged model indicated that cognitive functioning at baseline significantly predicted subsequent psychological distress. However, distress was not significantly associated with subsequent cognitive functioning. Additionally, the objective and subjective measures of cognitive functioning were not significantly correlated. These findings suggested that distress may occur as a consequence of poorer cognitive functioning in elderly, but not vice versa. The lack of correlation between objective and subjective cognitive measures suggested that the participants may not have adequate insight into their cognitive abilities. The implications of these findings are discussed.

Neuropsychiatric and Cognitive Subtypes among Community-Dwelling Older Persons and the Association with DSM-5 Mild Neurocognitive Disorder: Latent Class Analysis

The differential diagnosis between Alzheimer’s disease (AD) and vascular dementia (VaD) are still roughly problematic in clinical practice, despite the widely used diagnostic criteria to differentiate between the two disorders. There is an increasing evidence that cerebrovascular dysfunction plays a role not only in vascular causes of cognitive alterations but also in AD. Cognitively patients, with AD, show sometimes mixed degrees of associated vascular lesions in 30-60% of AD cases. In opposition, AD pathology may be present in 40%-80% of VaD patients, thus impeding diagnosis accuracy. Therefore, to eliminate this bewilderment and discrepancies in the diagnosis between the AD and VaD, it is worthy to shed light firstly on a disease that is a microangiopathy and represents VaD with clear milestones and features as is the case of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Studying CADASIL CSF biomarkers profile, will help in the differential diagnosis between both diseases sharing the coexisting neurodegeneration, furthermore, CADASIL is a dominantly inherited mid-adult life disorder causing ischemic strokes, which belongs to vasculopathies and symbolizes a genuine prototype of VaD that provides a valuable opportunity for studying its CSF biomarkers. Secondly, examining and evaluating the CSF biomarkers of AD compared to that of CADASIL. The pathogenesis similarities between CADASIL and early onset AD affecting the small vessels of the brain have suggested plausible molecular mechanisms involved in vascular damage and their impact on brain function and also come from the fact that in both diseases genetic mutations occur. CADASIL mutations in NOTCH3 gene generate toxic protein aggregates (Granular Osmiophilic Material- GOM) in the vicinity of vascular smooth muscle cells (VSMCs) causing degeneration and loss of VSMCs in small arteries and arterioles of white matter regions of the brain that lead to dementia, similar to those attributed to mutant forms of the Amyloid Precursor proteins (APP) and presenilins genes who cause overproduction and accumulations of the toxic Aβ42 protein in the brain and collapse of Aβ42 clearance mechanisms in AD. Despite the presumed pathological similarities, substantial differences between the two phenomena may exist especially in the CSF neurochemical phenotypes. To examine this aspect, which may help in the differential diagnosis, we carried out this review.

Directional associations between memory impairment and depressive symptoms: data from a longitudinal sample and meta-analysis

BACKGROUND Previous cross-lagged studies on depression and memory impairment among the elderly have revealed conflicting findings relating to the direction of influence between depression and memory impairment. The current study aims to clarify this direction of influence by examining the cross-lagged relationships between memory impairment and depression in an Asian sample of elderly community dwellers, as well as synthesizing previous relevant cross-lagged findings via a meta-analysis. METHODS A total of 160 participants (Mage = 68.14, s.d. = 5.34) were assessed across two time points (average of 1.9 years apart) on measures of memory and depressive symptoms. The data were then fitted to a structural equation model to examine two cross-lagged effects (i.e. depressive symptoms→memory; memory→depressive symptoms). A total of 14 effect-sizes for each of the two cross-lagged directions were extracted from six studies (including the present; total N = 8324). These effects were then meta-analyzed using a three-level mixed effects model. RESULTS In the current sample, lower memory ability at baseline was associated with worse depressive symptoms levels at follow-up, after controlling for baseline depressive symptoms. However, the reverse effect was not significant; baseline depressive symptoms did not predict subsequent memory ability after controlling for baseline memory. The results of the meta-analysis revealed the same pattern of relationship between memory and depressive symptoms. CONCLUSIONS These results provide robust evidence that the relationship between memory impairment and depressive symptoms is unidirectional; memory impairment predicts subsequent depressive symptoms but not vice-versa. The implications of these findings are discussed.