M. Arts

Physical Frailty and Cognitive Functioning in Depressed Older Adults: Findings From the NESDO Study

OBJECTIVES Cognitive frailty has recently been defined as the co-occurrence of physical frailty and cognitive impairment. Late-life depression is associated with both physical frailty and cognitive impairment, especially processing speed and executive functioning. The objective of this study was to investigate the association between physical frailty and cognitive functioning in depressed older persons. DESIGN Baseline data of a depressed cohort, participating in the Netherlands Study of Depression in Older persons (NESDO). SETTING Primary care and specialized mental health care. PARTICIPANTS A total of 378 patients (≥60 years) with depression according to DSM-IV criteria and a MMSE score of 24 points or higher. MEASUREMENTS The physical frailty phenotype as well as its individual criteria (weight loss, weakness, exhaustion, slowness, low activity). Cognitive functioning was examined in 4 domains: verbal memory, working memory, interference control, and processing speed. RESULTS Of the 378 depressed patients (range 60-90 years; 66.1% women), 61 were classified as robust (no frailty criteria present), 214 as prefrail (1 or 2 frailty criteria present), and 103 as frail (≥3 criteria). Linear regression analyses, adjusted for confounders, showed that the severity of physical frailty was associated with poorer verbal memory (ß = -0.13, P = .039), slower processing speed (ß = -0.20, P = .001), and decreased working memory (ß = -0.18, P = .004), but not with changes in interference control (ß = 0.04, P = .54). CONCLUSION In late-life depression, physical frailty is associated with poorer cognitive functioning, although not consistently for executive functioning. Future studies should examine whether cognitive impairment in the presence of physical frailty belongs to cognitive frailty and is indeed an important concept to identify a specific subgroup of depressed older patients, who need multimodal treatment strategies integrating physical, cognitive, and psychological functioning.

Relationship Between Physical Frailty and Low-Grade Inflammation in Late-Life Depression

To determine whether physical frailty is associated with low‐grade inflammation in older adults with depression, because late‐life depression is associated with physical frailty and low‐grade inflammation.

The role of frailty in the association between depression and somatic comorbidity: results from baseline data of an ongoing prospective cohort study

BACKGROUND Depression and physical frailty in older persons are both associated with somatic diseases, but are hardly examined in concert. OBJECTIVES To examine whether depression and physical frailty act independently and/or synergistically in their association with somatic diseases. DESIGN Baseline data of an ongoing observational cohort study including depressed cases and non-depressed comparison subjects. SETTINGS Netherlands Study of Depression in Older persons (NESDO). PARTICIPANTS 378 depressed older persons confirmed by the Composite International Diagnostic Interview (CIDI), version 2.1, and 132 non-depressed comparison subjects. METHODS Multiple linear regression analyses adjusted for socio-demographic and life-style characteristics were conducted with the number of somatic diseases as the dependent variable and depression and physical frailty as independent variables. Physical frailty was defined as ≥3 of the following characteristics, slowness, low physical activity, weight loss, exhaustion, and weakness. RESULTS Depression and physical frailty did not interact in explaining variance in the number of somatic diseases (p=.57). Physical frailty, however, partly mediated the association between depression and somatic diseases, as the strength of this association decreased by over 10% when frailty was added to the model (B=0.47, p=.003, versus B=0.41, p=.01). The mediation effect was primarily driven by the frailty criterion exhaustion. Of the remaining frailty components, only slowness was associated with the number of somatic diseases; but this association was fully independent of depression. CONCLUSIONS Our results suggest that depression and physical frailty have common pathways towards somatic diseases, as well as unique pathways. As no high-risk group was identified (no significant interaction), mental health nurses should regularly monitor for physical frailty within their caseload of depressed patients.

The impact of frailty on depressive disorder in later life: Findings from the Netherlands Study of depression in older persons

BACKGROUND Physical frailty and depressive symptoms are reciprocally related in community-based studies, but its prognostic impact on depressive disorder remains unknown. METHODS A cohort of 378 older persons (≥60 years) suffering from a depressive disorder (DSM-IV criteria) was reassessed at two-year follow-up. Depressive symptom severity was assessed every six months with the Inventory of Depressive Symptomatology, including a mood, motivational, and somatic subscale. Frailty was assessed according to the physical frailty phenotype at the baseline examination. RESULTS For each additional frailty component, the odds of non-remission was 1.24 [95% CI=1.01-1.52] (P=040). Linear mixed models showed that only improvement of the motivational (P<001) subscale and the somatic subscale (P=003) of the IDS over time were dependent on the frailty severity. CONCLUSIONS Physical frailty negatively impacts the course of late-life depression. Since only improvement of mood symptoms was independent of frailty severity, one may hypothesize that frailty and residual depression are easily mixed-up in psychiatric treatment.

Leucocyte telomere length is no molecular marker of physical frailty in late-life depression

Background Although average life‐expectancy is still increasing worldwide, ageing processes markedly differ between individuals, which has stimulated the search for biomarkers of biological ageing. Objectives Firstly, to explore the cross‐sectional and longitudinal association between leucocyte telomere length (LTL) as molecular marker of ageing and the physical frailty phenotype (PFP) as a clinical marker of ageing and secondly, to examine whether these associations are moderated by the presence of a depressive disorder, as depression can be considered a condition of accelerated ageing. Methods Among 378 depressed older patients (according to DSM‐IV criteria) and 132 non‐depressed older persons participating in the Netherlands Study of Depression in Older persons, we have assessed the physical frailty phenotype and LTL. The PFP was defined according to Frieds criteria and its components were reassessed at two‐year follow‐up. Results LTL was neither associated with the PFP at baseline by Spearman rank correlation tests, nor did it predict change in frailty parameters over a two‐year follow‐up using regression analyses adjusted for potential confounders. Conclusion LTL is not associated with frailty; neither in non‐depressed nor in depressed older persons. As LTL and physical frailty appear to represent different aspects of ageing, they may complement each other in future studies. HighlightsLTL and physical frailty are significantly associated with chronological age.LTL is not associated with frailty; neither in non‐depressed nor in depressed elderly.LTL and physical frailty appear to represent different aspects of ageing.

Frailty as a Predictor of the Course of Late-life Depression: Findings From a Longitudinal Cohort Study

Abstract Background More than a quarter of depressed older persons is physically frail. Understanding the associations between frailty and depression may help to improve treatment outcome for late-life depression. The aim of this study is to test whether physical frailty predicts the course of late-life depression. Methods A cohort study (N=285) of depressed older persons aged ≥60 years with two years follow-up. Depression was classified according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria at baseline and at two-year follow-up. Severity of depression was assessed with the sum score as well as subscale scores of the Inventory of Depressive Symptomatology (IDS) at six-month intervals. Physical frailty was defined as ≥3 out of 5 criteria (handgrip strength, weight loss, poor endurance, walking speed, low physical activity). Results Frail patients were more severely depressed compared to their non-frail counterparts. Multivariable logistic regression showed that physical frailty at baseline was associated with depression at two years follow-up, adjusted for socio-demographics and lifestyle factors. Linear mixed models showed that improvement of mood symptoms over time was independent of frailty status, whereas frailty had a negative impact on the course of the somatic and motivational symptoms of depression. Conclusions The negative impact of physical frailty on the course of depression may point to the potential importance of incorporating multi-facetted interventions in the treatment of late-life depression. Further understanding of the mediating mechanisms underlying the association between frailty and depression may further guide the development of these interventions.

EPA-0154 – Influence of psychostimulants on temperament and character profiles in adult adhd patients

Introduction Several Clinical studies have shown specific Temperament and Character Profiles in adult ADHD patients. In all studies drug naive patients were included. Aim The present study was set up to assess whether adult ADHD patients referred to an outpatient clinic would show altered temperament and character profiles after they were put on psychostimulant medication. Method During 18 months patients were recruited randomly from two out patient Clinics in Western Brabant, The Netherlands. ADHD symptoms were rated with the ASRS-Dutch version and temperament and character with the VTCI, a shortened Dutch translation of the TCI. Patients were assessed just before the first prescription of psychostimulants (T0) and after subjective clinical effect of the medication (T1). Results 48 patients gave informed consent and in total 38 completed the study. Significant differences between T1 and T0 were found for Novelty Seeking, Harm Avoidance, Self- Directedness and Self-Transcendence. Conclusion Adult ADHD patients can experience significant differences in temperament and character profiles after taking psychostimulant medication, suggesting different attitudes in daily life like carefulness, resilience, selfimage and sense of belonging are encouraged. It is important to discuss these issues with ADHD patients.