American Journal of Geriatric Psychiatry最新文献

{"title":"Apathy Endorsement in Late Life Depression is Associated with Executive Dysfunction","authors":"Maria Kryza-Lacombe PhD ,&nbsp;Michelle Kassel PhD ,&nbsp;Susanna Fryer PhD ,&nbsp;Philip S. Insel PhD ,&nbsp;Branwen Vang BA ,&nbsp;Meryl A. Butters PhD ,&nbsp;Paul Aisen MD ,&nbsp;Rema Raman PhD ,&nbsp;Susan Landau PhD ,&nbsp;Andrew J. Saykin PsyD ,&nbsp;Arthur W. Toga MD ,&nbsp;Clifford R. Jack Jr. MD ,&nbsp;Michael W. Weiner MD ,&nbsp;Craig Nelson MD ,&nbsp;Duygu Tosun PhD ,&nbsp;R. Scott Mackin PhD","doi":"10.1016/j.jagp.2024.01.120","DOIUrl":"https://doi.org/10.1016/j.jagp.2024.01.120","url":null,"abstract":"<div><h3>Introduction</h3><p>Executive function deficits are prevalent in late life depression (LLD) and linked to poorer outcomes. Little is known about the underlying factors that contribute to greater executive dysfunction in LLD, yet understanding these factors is critical for identifying new intervention targets to reduce the public health burden associated with depression and cognitive impairment in late life. Although negative affect has traditionally been the focus of scientific inquiry related to depressive symptomatology, emerging work is highlighting associations of Positive Valence System (PVS) dysfunction with depression. PVS functions are characterized by positive affect and approach behaviors toward potentially rewarding stimuli and are associated with better cognitive control in non-depressed adults. PVS deficits such as apathy are common in LLD and present as diminished goal-directed behavior, decreased interest in activities, and flattened affect. One prior study found that greater apathy was significantly associated with lower executive function performance in LLD, but more work is needed to characterize associations between PVS functions and executive dysfunction, including impairment rates. To this end, we examined associations between apathy endorsement in LLD and 1) performance on executive function measures and 2) rates of executive function impairment.</p></div><div><h3>Methods</h3><p>Baseline assessments of older adults with Major Depressive Disorder (N=228, Ages 65-91) were pooled across two studies: a longitudinal observational study (n=127) and a psychotherapy study (n=101). Participants completed measures of depression (15-item Geriatric Depression Scale [GDS], Hamilton Depression Rating Scale [HDRS]) and executive functions (EF; Trail Making Test B [TMTB], Stroop Color Word Interference [SCWI]) yielding raw scores and demographically corrected impairment ratings (i.e., performance at least 1 standard deviation below the normative mean). Apathy was defined as endorsement of having dropped many activities and interests (GDS, item 2). Differences in EF test performance by apathy status (present vs. absent) were first assessed by comparing raw scores (log-transformed for TMTB due to skewness) via independent samples t-tests (adjusted for unequal variances in performance scores between apathy groups). Linear regression analyses were additionally conducted to assess performance differences by apathy status after adjusting for demographic characteristics (age, gender, education) and concurrent depression severity (HDRS). Chi-square tests compared rates of demographically corrected EF impairment by apathy status and were followed up by logistic regression analyses to examine whether apathy status is associated with EF impairment differences after adjusting for concurrent depression severity.</p></div><div><h3>Results</h3><p>Apathy was endorsed by 67.5% of participants and was associated with significantly poorer performance","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":null,"pages":null},"PeriodicalIF":7.2,"publicationDate":"2024-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139907838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}