Shuichi Awata

Reliability and validity of the Japanese version of the World Health Organization-Five Well-Being Index in the context of detecting depression in diabetic patients.

Abstract  The present study had two aims. The first was to evaluate the reliability and the validity of the Japanese version of the World Health Organization (WHO)‐Five Well‐Being Index (WHO‐5‐J) as a brief well‐being scale. The second was to examine the discriminatory validity of this test as a screening tool for current depressive episodes in diabetic patients. A sample of 129 diabetic patients completed the WHO‐5‐J. Of these, 65 were also interviewed by psychiatrists to assess whether they had any current depressive episodes according to DSM‐IV. The internal consistency was evaluated using Cronbach’s alpha, the Loevinger coefficient of homogeneity, and factor analysis. The external concurrent validity was evaluated by correlations with the external scales potentially related to subjective well‐being. Discriminatory validity was evaluated using receiver operating characteristic (ROC) analysis. Cronbach’s alpha and the Loevinger coefficient were estimated to be 0.89 and 0.65, respectively. A factor analysis identified only one factor. The WHO‐5‐J was significantly correlated with a number of major diabetic complications, depression, anxiety, and subjective quality of life. ROC analysis showed that the WHO‐5‐J can be used to detect a current depressive episode (area under curve: 0.92; 95% confidence interval: 0.85–0.98). A cut‐off of <13 yielded the best sensitivity/specificity trade‐off: sensitivity, 100%; specificity, 78%. The WHO‐5‐J was thus found to have a sufficient reliability and validity, indicating that it is a useful instrument for detecting current depressive episodes in diabetic patients.

Green tea consumption is associated with depressive symptoms in the elderly

BACKGROUND Green tea is reported to have various beneficial effects (eg, anti-stress response and antiinflammatory effects) on human health. Although these functions might be associated with the development and progression of depressive symptoms, no studies have investigated the relation between green tea consumption and depressive symptoms in a community-dwelling population. OBJECTIVE The aim of this study was to investigate the relations between green tea consumption and depressive symptoms in elderly Japanese subjects who widely consumed green tea. DESIGN We conducted a cross-sectional study in 1058 community-dwelling elderly Japanese individuals aged >or=70 y. Green tea consumption was assessed by using a self-administered questionnaire, and depressive symptoms were evaluated by using the 30-item Geriatric Depression Scale with 2 cutoffs: 11 (mild and severe depressive symptoms) and 14 (severe depressive symptoms). If a participant was consuming antidepressants, he or she was considered to have depressive symptoms. RESULTS The prevalence of mild and severe and severe depressive symptoms was 34.1% and 20.2%, respectively. After adjustment for confounding factors, the odds ratios (95% CI) for mild and severe depressive symptoms when higher green tea consumption was compared with green tea consumption of <or=1 cup/d were as follows: 2-3 cups green tea/d (0.96; 95% CI: 0.66, 1.42) and >or=4 cups green tea/d (0.56; 95% CI: 0.39, 0.81) (P for trend: 0.001). Similar relations were also observed in the case of severe depressive symptoms. CONCLUSION A more frequent consumption of green tea was associated with a lower prevalence of depressive symptoms in the community-dwelling older population.

Factors associated with suicidal ideation in an elderly urban Japanese population: A community‐based, cross‐sectional study

Abstract  The objective of the present study was to evaluate the association between suicidal ideation and potentially related factors in an elderly urban Japanese population. This was a community‐based, cross‐sectional study. Urban community residents aged 70 years or more were interviewed regarding suicidal ideation and sociodemographic and health‐related variables. Subjects with depressive symptoms underwent further evaluation by psychiatrists using criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Associations were evaluated using univariate and multivariate logistic regression analyses. Of the 1145 eligible participants, 52 (4.5%) reported thoughts of suicide. Of 143 subjects with depressive symptoms (Geriatric Depression Scale, 14+), 22 (15.4%) reported suicidal ideation over a 2‐week period. After controlling for depressive symptoms, lack of social support and impaired instrumental activities of daily living were significantly associated with thoughts of suicide. After controlling for the potentially associated factors detected in the univariate analysis, depressive symptoms were strongly associated with thoughts of suicide. In the elderly with depressive symptoms, mental disorders, including depressive and alcohol‐related disorders, were significantly associated with suicidal ideation over a 2‐week period. In the urban community setting, screening for lack of social support, impaired instrumental activities of daily living, and depressive symptoms, followed by diagnostic evaluation for mental disorders, particularly for depressive syndromes and alcohol‐related disorders, may provide a practical and effective means of identifying elders at high risk of suicide.

Effects of Intervention Using a Community-Based Walking Program for Prevention of Mental Decline: A Randomized Controlled Trial

To evaluate the efficacy of a municipality‐led walking program under the Japanese public Long‐Term Care Insurance Act to prevent mental decline.

Association between social support and depression status in the elderly: Results of a 1‐year community‐based prospective cohort study in Japan

Abstract  We conducted a prospective cohort study on subjects aged ≥ 70 years in an urban community to determine whether there is any association between lack of social support and depression status. Of the 2730 eligible subjects, 1178 participated and were interviewed in a Comprehensive Geriatric Assessment (CGA) in 2002. We investigated the five social supports items using the following questions: (i) do you have someone with whom you can consult when you are in trouble?, (ii) do you have someone with whom you can consult when your physical condition is not good?, (iii) do you have someone who can help you with your daily housework?, (iv) do you have someone who can take you to a hospital when you do not feel well?, and (v) do you have someone who can take care of you when you are ill in bed? The Geriatric Depression Scale was used to estimate depression status. The subjects were divided into two groups: depressive and non‐depressive. Of 753 subjects classified as non‐depressive, 475 also took part in a CGA in 2003 and 278 dropped out. We calculated the risk of depression status in the elderly without social support. Lack of social support items (i) and (v) were significantly associated with an increased risk of depression status. The multivariate odds ratios (95% confidence intervals) regarding the risk of depression status among the elderly without (i) and (v) social support items were 2.6 (1.2–5.3) and 3.0 (1.4–6.1), respectively. We also found the increase risk of depression status with lack of social support item (v) was significantly different for different sexes and for different pain conditions. We conclude that there is a significant increase in the risk of depression status associated with the lack of social support in Japanese elderly people in an urban community.

Regional cerebral blood flow abnormalities in late‐life depression:Relation to refractoriness and chronification

Abstract We examined patterns of regional cerebral blood flow (rCBF) abnormalities in 18 patients with major depressive disorder in late life using single photon emission computed tomography (SPECT) and (99mTc‐hexamethyl‐propylenamine oxime (99mTc‐HMPAO). Compared with 13 age‐matched controls, relative rCBF was significantly decreased bilaterally in the anterior cingulate gyrus, the prefrontal cortex, the temporal cortex, the parietal cortex, the hippocampus and the caudate nucleus. However, it was not correlated with the severity of depression or global cognitive dysfunction. In 10 patients with a prolonged depressive episode or prolonged residual symptoms (the refractory subgroup), robust and extensive decreases in rCBF were found compared with controls and the rCBF decreased significantly in the anterior cingulate gyrus and the prefrontal cortex compared with that in the non‐refractory subgroup. In the non‐refractory subgroup, rCBF decreased significandy in the caudate nucleus and tended to decrease in the anterior cingulate gyrus compared with controls. These findings indicate that dysfunction of the limbic system, the cerebral association cortex and the caudate nucleus may be implicated in late‐life depression and that robust and extensive hypoperfusion, especially in the anterior cingulate and the prefrontal regions, may relate to refractoriness or chronification of depression.

Behavioral and psychological symptoms of dementia characteristic of mild Alzheimer patients

Abstract  In order to clarify the characteristics of Behavioral and Psychological Symptoms of Dementia (BPSD) in patients with mild Alzheimers disease (AD), BPSD among the severities of Clinical Dementia Rating (CDR) in 74 patients with AD were compared using the Neuropsychiatric inventory (NPI). The result, when compared between mild (CDR = 0.5, 1) and moderate or severe (CDR = 2, 3) AD, was a significant difference in frequency of euphoria, disinhibition and aberrant motor behavior, but no significant difference was found in frequency of delusions, hallucinations, agitation, dysphoria, anxiety, apathy and irritability. In addition, a significant difference was found in the mean scores of the composite score for euphoria, apathy, disinhibition and aberrant motor behavior, but no significant difference was found in the mean scores of the composite score for delusions, hallucinations, agitation, dysphoria, anxiety and irritability. That is, the mild AD groups (CDR 0.5 or 1) had delusions, hallucinations, agitation, dysphoria, anxiety, apathy and irritability as frequently as the moderate or severe AD groups (CDR 2 or 3), and had the equivalent level of composite scores to the moderate or severe AD groups (CDR 2 or 3) in delusion, hallucination, agitation, dysphoria, anxiety and irritability. Therefore, it was supposed that psychotic symptoms (delusion, hallucination) and emotional symptoms (agitation, dysphoria, anxiety, irritability) are important BPSD in patients with mild AD as well as those with moderate or severe AD, and there are needs for health, welfare and medical services for these symptoms.

Neuropathy is associated with depression independently of health-related quality of life in Japanese patients with diabetes

Objectives:  To identify factors independently associated with depression in Japanese patients with diabetes, after controlling for potential confounding factors.

Changes in regional cerebral blood flow abnormalities in late‐life depression following response to electroconvulsive therapy

Abstract The impact of electroconvulsive therapy (ECT) on the regional cerebral blood flow (rCBF) abnormalities in late‐life depression is still unknown and the clinical significance of these findings in late‐life depression has not been fully discussed. Using single photon emission computed tomography (SPECT) with 99mTc‐hexamethylpropylene amine oxime (99mTc‐HMPAO), we examined the changes of rCBF patterns in nine late‐life patients with major depressive episodes before and following response to ECT compared with nine age‐ and sex‐matched healthy volunteers. Statistical comparisons were made on both region‐of‐interest (ROI) and voxel‐by‐voxel bases. In ROI‐based analyses, a mean rCBF was significantly decreased in the patients before ECT compared with the control, significantly increased (normalized) in the patients 2 weeks after ECT compared with that before ECT, and still increased in the patients 12 weeks after ECT compared with that before ECT. In voxel‐by‐voxel analyses, a significant rCBF reduction was found in the bilateral pre‐ and subcallosal anterior cingulate cortex, the bilateral caudal orbitofrontal cortex, the right insular cortex and the right posterior middle frontal gyrus in patients before ECT compared with the control, and similar rCBF patterns were shown at 2 weeks and 12 weeks after ECT. We propose the hypothesis that a mean rCBF reduction may have a state‐related property while persistent anterior paralimbic hypoperfusion may have a trait‐like property, which relates to the relapse vulnerability as well as a tendency toward medication failure and illness chronicity in late‐life depression.

Tc-99m HMPAO SPECT in the evaluation of Alzheimer’s disease: correlation between neuropsychiatric evaluation and CBF images

The purpose of this study was to evaluate the effects of various covariants on the distribution pattern of Tc-99m HMPAO in patients with Alzheimer’s disease by correlation analysis. Twenty patients with Alzheimer’s disease and 15 age matched normal subjects participated. Tc-99m HMPAO brain SPECT and xray computed tomography (CT) were acquired for each subject. SPECT images were transformed to a standard size and shape by automated image registration (AIR) and were used for group comparison by means of SPM96. Voxel based covariance analysis was performed on standardised images taking the age of patients, severity of disease (clinical dementia rating scale, mini mental state examination, physical self maintenance scale), and atrophy indices as variables. There was significantly decreased regional cerebral blood flow (rCBF) in the frontal, parietal, and temporal regions in the patient group (p<0.001), more marked in those patients having severe dementia. Covariance analysis disclosed that aging and severity of disease have a pronounced effect on rCBF, especially that of the left parietal region.