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To investigate the presence, nature and direction of the daily temporal association between depressive symptoms, cognitive performance and sleep in older individuals.
Design, setting, participants:
Single-subject study design in eight older adults with cognitive impairments and depressive symptoms.
For 63 consecutive days, depressive symptoms, working memory performance and night-time sleep duration were daily assessed with an electronic diary and actigraphy. The temporal associations of depressive symptoms, working memory and total sleep time were evaluated for each participant separately with time-series analysis (vector autoregressive modeling).
For seven out of eight participants we found a temporal association between depressive symptoms and/or sleep and/or working memory performance. More depressive symptoms were preceded by longer sleep duration in one person (r = 0.39; p < .001), by longer or shorter sleep duration than usual in one other person (B = 0.49; p < .001), by worse working memory in one person (B = −0.45; p = .007), and by better working memory performance in one other person (B = 0.35; p = .009). Worse working memory performance was preceded by longer sleep duration (r = −.35; p = .005) in one person, by shorter or longer sleep duration in three other persons (B = −0.76; p = .005, B = −0.61; p < .001; B = −0.34; p = .002), and by more depressive symptoms in one person (B = −0.25; p = .009).
The presence, nature and direction of the temporal associations between depressive symptoms, cognitive performance and sleep differed between individuals. Knowledge of personal temporal associations may be valuable for the development of personalized intervention strategies in order to maintain their health, quality of life, functional outcomes and independence.
Depression and cognitive impairments often co-occur in older adults and account for a high disease burden. Insight into how affect and cognitive function influence one another on a daily basis could be helpful in the diagnostic process and treatment decisions for individual patients. However, little is known about the daily associations between affect and cognitive function in older adults and it is unknown whether these associations differ per person. Therefore, the objective of this study was to get insight into the temporal associations between affect and cognitive function within individual older adults.
Materials & Methods
For this single-subject study eight older adults with depression and cognitive impairments filled in electronic diaries for 63 consecutive days in their home environment. The diaries included a questionnaire evaluating positive affect (PA), negative affect (NA) and a computerized cognitive test battery assessing working memory reaction time (WMRT) and visual learning accuracy (VLA). Time-series analyses using Vector Autoregressive (VAR) modelling were conducted for each individual separately. Granger causality tests were used to determine the temporal direction of the individual associations. Cumulative Orthogonalized Impulse Response Function (COIRF) analyses were performed in order to determine the cumulative effect size over a 10-day period. The contemporaneous associations were derived from the correlation between the residuals in the VAR model.
For one out of eight participants higher NA was associated with better WMRT the next day (cumulative effect size=0.345; p=0.005). For another participant higher NA and lower PA were associated with worse WMRT at the same time (r=-0.369; p=0.003 and r=0.352; p=0.005, respectively). For a third participant better VLA was associated with lower NA (cumulative effect size=-0.569; p<0.001) and higher PA the next day (cumulative effect size=0.223; p=0.001). The other five participants showed no contemporaneous or lagged association between affect and cognitive function.
For the majority of individuals we found no contemporaneous or temporal association between affect and cognitive functioning. For the others, the associations differed in direction, sign and size. This highlights heterogeneity even in a small and relatively homogeneous sample. Future studies should evaluate how individual data can be used in personalizing diagnoses and treatments.
General anxiety and depressive symptoms following a myocardial infarction are associated with a worse cardiac prognosis. However, the contribution of specific aspects of anxiety within this context remains unclear.
To evaluate the independent prognostic association of cardiac anxiety with cardiac outcome after myocardial infarction.
We administered the Cardiac Anxiety Questionnaire (CAQ) during hospital admission (baseline, n = 193) and 4 months (n = 147/193) after discharge. CAQ subscale scores reflect fear, attention, avoidance and safety-seeking behaviour. Study end-point was a major adverse cardiac event (MACE): readmission for ischemic cardiac disease or all-cause mortality. In Cox regression analysis, we adjusted for age, cardiac disease severity and depressive symptoms.
The CAQ sum score at baseline and at 4 months significantly predicted a MACE (HRbaseline = 1.59, 95% CI 1.04–2.43; HR4-months = 1.77, 95% CI 1.04–3.02) with a mean follow-up of 4.2 (s.d. = 2.0) years and 4.3 (s.d. = 1.7) years respectively. Analyses of subscale scores revealed that this effect was particularly driven by avoidance (HRbaseline = 1.23, 95% CI 0.99–1.53; HR4-months = 1.77, 95% CI 1.04–1.83).
Cardiac anxiety, particularly anxiety-related avoidance of exercise, is an important prognostic factor for a MACE in patients after myocardial infarction, independent of cardiac disease severity and depressive symptoms.
In depressed persons, thoughts of death and suicide are assumed to represent different degrees of a construct: suicidality. However, this can be questioned in older persons facing physical and social losses. Thoughts of death in depressed older persons are hardly examined in the absence of suicidal ideation. Furthermore, most depression instruments do not discriminate suicidal ideation from thoughts of death only. We examined whether determinants of thoughts of death differ from determinants of suicidal ideation in late life depression.
Past month's thoughts of death and suicidal ideation were assessed with the Composite International Diagnostic Interview in 378 depressed older persons (>60 years of age). Multinomial logistic regression analyses adjusted for age and depression severity were used to identify socio-demographic, lifestyle, clinical and somatic determinants of past month's thoughts of death, and suicidal ideation.
Compared with patients without thoughts of death or suicide (n = 267), patients reporting thoughts of death but no suicidal ideation (n = 74) were older (OR (95% confidence interval) = 1.04 (1.00–1.08)) and more severely depressed (OR = 1.06 (1.04–1.08)), whereas patients with suicidal ideation (n = 37) were also more severely depressed (OR = 1.09 (1.06–1.13)), but not older. This latter group was further characterized by more psychiatric comorbidity (dysthymia OR = 2.28 (1.08–4.85)), panic disorder (OR = 2.27 (1.00–518)), at-risk alcohol use (OR = 4.10 (1.42–11.90)), lifetime suicide attempts (OR = 3.37 (1.46–7.75)), loneliness (OR = 1.24 (1.07–1.43)), and recent life events (OR = 3.14 (1.48–6.67)).
In depressed older persons thoughts of death and suicide differ in relevant demographic, social, and clinical characteristics, suggesting that the risks and consequences of the two conditions differ.
Few studies have addressed the relationship between generalised anxiety disorder and cardiovascular prognosis using a diagnostic interview.
To assess the association between generalised anxiety disorder and adverse outcomes in patients with myocardial infarction.
Patients with acute myocardial infarction (n = 438) were recruited between 1997 and 2000 and were followed up until 2007. Current generalised anxiety disorder and post-myocardial infarction depression were assessed with the Composite International Diagnostic Interview. The end-point consisted of all-cause mortality and cardiovascular-related readmissions.
During the follow-up period, 198 patients had an adverse event. Generalised anxiety disorder was associated with an increased rate of adverse events after adjustment for age and gender (hazard ratio: 1.94; 95% confidence interval: 1.14–3.30; P = 0.01). Additional adjustment for measures of cardiac disease severity and depression did not change the results.
Generalised anxiety disorder was associated with an almost twofold increased risk of adverse outcomes independent demographic and clinical variables and depression.
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