Relationship of Cognition, Depression and Anxiety to Glycemic Control in Older Adults with Diabetes

Objective: This study aimed to assess the relationship of cognition, depression and anxiety to glycemic control in elders with diabetes. DM is a chronic medical condition. Its control depends on adherence to medical therapy and making decisions related to lifestyle changes. This decision making capacity is affected by many factors including cognition and psychological status. Design: It was a case control study. Setting: It was done in Ain Shams University Hospital inpatients and DM outpatient clinic, Cairo, Egypt. Participants: Of the one hundred diabetic patients aged ≥ 60 years, 50 had Hemoglobin A1c (HbA1c) ≥ 7.5 (cases) and 50 had Hb A1c 7.5 (controls). Measurements: Cognition was assessed using minimental status examination (MMSE) test, Mattis Organic Mental Syndrome Screening Examination (MOMSSE) and Cambridge Cognitive Examination (CAMCOG) test. Geriatric depression scale-15 (GDS-15) was performed for depression assessment, while anxiety was assessed by DSM IV criteria. Laboratory investigations included: fasting blood sugar (FBS), post-prandial blood sugar (PPBS), glycated haemoglobin (Hb A1c), low density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol, and triglycerides (TG). Results: Significant difference was found between the two groups regarding scores of cognitive tests: MMSE score (p = 0.004);below average (p = 0.02) and average scores (p = 0.05) of MOMSSE;CAMCOG score (p = 0.015);and CAMCOG divided items score including orientation (p = 0.003), comprehension (p = 0.005), expression (p = 0.020), attention (p = 0.002), and abstraction (p = 0.008) as well as depression screening scores (P = 0.002). Using Receiver Operating Characteristic, CAMCOG had better sensitivity and MOMSSE had better specificity. Conclusion: Cognitive impairment was associated with poor glycemic control, and impairment in attention and abstraction, related to executive function, functions were found to be associated with poor glycemic control. These functions may be more needed in self management of DM and hence affected glycemic control. Depression was associated with poor glycemic control but anxiety was not.

NP-12 The Phosphodiesterase-4 Inhibitor Roflumilast Reverses Cognition Deficits and Depression-Like Effects via cAMP Signaling-Mediated Neuroprotection in APP/PS1 Transgenic Mice

Phosphodiesterase-4(PDE4)has been demonstrated to be a promising target for treatment of Alzheimer’s disease(AD).Roflumilast(Rof),a potent PDE4 inhibitor,has been approved for treatment of chronic obstructive pulmonary disease(COPD)in humans.Recent studies have shown that Rof improves cognition at doses that do not cause an emetic response,the major side-effect of PDE4 inhibitors.However,the effect of Rof on cognition associated with AD remains largely unknown.Here we examined the effects of Rof on behavioral dysfunction and the related mechanisms in APP/PS1 double transgenic mice,a widely used model for AD.Mice at 10 months of age were first tested in novel object recognition for memory.The recognition index in APP/PS1 mice was decreased compared to WT mice,which was reversed by Rof at 5 and 10 mg·kg-1.This was then verified in the Morris water-maze test.The escape latency during acquisition training was significantly longer and the entries into the target quadrant during the probe trial were much less compared to WT controls,these were also reversed by Rof.In the tail-suspension and forced-swimming tests,which measure depression-like behavior,APP/PS1 mice showed prolonged immobility time,which was reversed by Rof.In addition,the staining of HE and Nissl showed that Rof reduced the loss of neurons and neurocyte apoptosis in APP/PS1 mice.It also reversed the decreased ratio of Bcl-2/BAX and inhibited the increased expression of PDE4D in the cerebral cortex and hippocampus of APP/PS1 mice.Finally,Rof reversed the decreased levels of cAMP and expression of phosphorylated cAMP response element-binding protein(CREB)and brain derived neurotrophic factor(BDNF)in APP/PS1 mice.Overall,these results suggest that Rof not only improves learning and memory,but attenuates depression-like behavior in AD mice,likely via PDE4D/cAMP/CREB/BDNF signaling-mediated neuroprotection.Therefore,Rof can be a therapeutic agent for AD,in particular the comorbidity of memory deficits and depression.

Psychological intervention based on social cognitive theory: Treating pain, anxiety, and depression in perioperative patients

BACKGROUND Surgery is an effective method for treating certain diseases.Factors such as disease,preoperative fear and tension,surgical stress,postoperative pain,and related complications directly affect the smooth progression and outcome of surgery.Patients may experience a series of psychological and physiological changes during the perioperative period,resulting in anxiety and depression,which may reduce the pain threshold and worsen their prognosis.METHODS We enrolled 200 patients who underwent surgical care at The First People’s Hospital of Lin’an District,Hangzhou between January and December 2023.They were categorized into a routine intervention group(n=103)and a psychological intervention group(n=97),based on the intervention strategies used.Various assessment tools,including the self-rating anxiety scale(SAS),the self-rating depression scale(SDS),and the Connor–Davidson Resilience scale,were used to measure patients’negative states and emotions.The pre-and post-intervention scores for these metrics in the two groups were then analyzed.RESULTS In the psychological intervention group,the SAS and SDS scores(31.56±5.18 and 31.46±4.57,respectively)were significantly reduced compared to the routine intervention group(P<0.05).The visual analog scale pain scores at 12 and 24 hours after intervention(6.85±1.21,4.24±0.72)were notably higher than those in the routine intervention group(P<0.05).The psychological intervention group also demonstrated superior scores in perseverance(36.08±3.29),self-reliance(22.63±2.91),optimism(11.42±1.98),and resilience(70.13±5.37),compared to the routine intervention group(P<0.05).Additionally,the psychological intervention group’s confrontation score(23.16±4.29)was higher(P<0.05).This group also reported lower scores in avoidance(9.28±1.94)and yielding(6.19±1.92)(P<0.05).Lastly,the Short Form 36 Health Survey scores were significantly higher in the psychological intervention group,indicating a better quality of life(P<0.05).CONCLUSION Psychological intervention measures based on SCT can effectively alleviate pain,anxiety,and depression in periop-erative patients.

Outcomes of the effect of exercise on cognitive function in patients with depression:A meta-analysis

BACKGROUND Major depressive disorder is a common mental disorder,characterized by a high rate of suicide and recurrence,which is frequently accompanied by cognitive impairments,particularly in executive function,memory,attention,and infor-mation processing speed.As such,improving the cognitive function in patients with depression and enhancing their quality of life are urgent issues.AIM To perform a systematic review and meta-analysis of the effects of exercise on cognitive function in patients with depression.METHODS The PubMed,Web of Science,Cochrane Library,Embase,China National Knowledge Infrastructure,Wanfang Medical,VIP,and Biomedical Databases for randomized controlled trials(RCTs)databases were searched(from inception to October 19,2023)for studies investigating improvements in cognitive function in patients with depression through exercise.Tools recommended by the Cochrane Handbook for RCT evaluation,and GRADEpro and Stata17 software,were employed for risk of bias assessment,evidence grading,forest plot construction,subgroup and sensitivity analyses,and assessment of publication bias.RESULTS Seventeen RCTs(1173 patients with depression)were included.Exercise had a small but significant positive effect on attention,with an effect size of 0.21,95%CI:0.07-0.34,P<0.01.Specifically,aerobic exercise regimens of 30-60 minute/session,thrice a week,at moderate intensity,and sustained over 3-12 weeks,were associated with the most pronounced benefits(P<0.05),with effect sizes for executive function,memory,and information processing speed of 0.11,95%CI:-0.11-0.32,P=0.34;0.08,95%CI:0.00-0.16,P=0.05;and 0.14,95%CI:0.04-0.25,P=0.01,respectively.The evidence levels for attention,information processing speed,and memory were rated as'low,’whereas that for executive function was rated as'very low’.CONCLUSION Exercise could improve attention and information-processing speed in patients with depression,although improvements in executive function and memory are not significant.

Abnormalities of electroencephalography microstates in patients with depression and their association with cognitive function

BACKGROUND A growing number of recent studies have explored underlying activity in the brain by measuring electroencephalography(EEG)in people with depression.However,the consistency of findings on EEG microstates in patients with depression is poor,and few studies have reported the relationship between EEG microstates,cognitive scales,and depression severity scales.AIM To investigate the EEG microstate characteristics of patients with depression and their association with cognitive functions.METHODS A total of 24 patients diagnosed with depression and 32 healthy controls were included in this study using the Structured Clinical Interview for Disease for The Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition.We collected information relating to demographic and clinical characteristics,as well as data from the Repeatable Battery for the Assessment of Neuropsychological Status(RBANS;Chinese version)and EEG.RESULTS Compared with the controls,the duration,occurrence,and contribution of microstate C were significantly higher[depression(DEP):Duration 84.58±24.35,occurrence 3.72±0.56,contribution 30.39±8.59;CON:Duration 72.77±10.23,occurrence 3.41±0.36,contribution 24.46±4.66;Duration F=6.02,P=0.049;Occurrence F=6.19,P=0.049;Contribution F=10.82,P=0.011]while the duration,occurrence,and contribution of microstate D were significantly lower(DEP:Duration 70.00±15.92,occurrence 3.18±0.71,contribution 22.48±8.12;CON:Duration 85.46±10.23,occurrence 3.54±0.41,contribution 28.25±5.85;Duration F=19.18,P<0.001;Occurrence F=5.79,P=0.050;Contribution F=9.41,P=0.013)in patients with depression.A positive correlation was observed between the visuospatial/constructional scores of the RBANS scale and the transition probability of microstate class C to B(r=0.405,P=0.049).CONCLUSION EEG microstate,especially C and D,is a possible biomarker in depression.Patients with depression had a more frequent transition from microstate C to B,which may relate to more negative rumination and visual processing.

Cognitive Disorders, Depression and Anxiety in Temporal Lobe Epilepsy: An Overview

Partial epilepsies, originating in a specific brain region, affect about 60% of adults with epilepsy. Temporal lobe epilepsy (TLE) is the most prevalent subtype within this category, often necessitating surgical intervention due to its refractoriness to antiepileptic drugs (AEDs). Hippocampal sclerosis, a common underlying pathology, often exacerbates the severity by introducing cognitive and emotional challenges. This review delves deeper into the cognitive profile of TLE, along with the risk factors for cognitive disorders, depression, and anxiety in this population.

Neural and Cognitive Markers and Regulation of Emotion in Depression: A Mini-Review and a Short Case Report

In the presented short clinical case of depression, the constructs of Research Domain Criteria (RDoC) of loss (negative valence systems) and cognitive control (cognitive systems) have been operationalized. It has been concluded that a normal cognitive control of emotion, requiring the functional and structural integrity of prefrontal cortex (PFC) and orbitofrontal cortex (OFC), is lacking in depression, but its amelioration can be achieved through the implementation of cognitive remediation/rehabilitation programs. A mini-review on neural and cognitive markers and regulation of emotion in depression is previously presented.

Self-Frustration of Expectations in Major Depressive Disorder: The Syncytiopathy Hypothesis of Depression Revisited

This paper is a further elaboration of my model of the pathophysiology of major depressive disorder focusing on imbalances of glial-neuronal interactions in tripartite synapses and the glial network (syncytium). Basically, it is proposed that the connexin proteins building gap junctions in the glial syncytium are underexpressed or dysfunctional in major depression, called syncytiopathy. As a compensatory effect the astrocytic receptors in tripartite synapses are overexpressed. This leads to protracted synaptic information processing because of a relative lack of neurotransmitter substances for the occupancy of astrocytic receptors. Based on a new biophysical formal description of astrocytic receptors as expectation variables it can be shown that the protracted processing of sensory information frustrate the full comprehension of the expected event, since it cannot be grasped in time. Moreover, expectation frustration may stress the glial syncytium aggravating memory impairment. This cyclic process of dysbalanced synaptic information processing is characterized as self-frustration of expectations explanatory for the main cognitive dysfunctions in major depression as slowing down processing speed, deficits in attention and working memory. The main result of the study is that patients with major depression cannot fully acknowledge the existence of an intended event.

Gender Differences in the Incidence and Related Factors of Low Social Support among Adolescents with Subthreshold Depression

Background:Social support is related to depression,but the gender differences and related factors that contribute to low social support among adolescents with subthreshold depression remain to be elucidated.This study explores the relationship between social support and depression,in addition to the gender difference in the incidence of low social support among adolescents with subthreshold depression and its related factors.Methods:A total of 371 Chinese adolescents with subthreshold depression were recruited.All subjects were rated on the Social Support Scale for Adolescents,the Response Style Scale,the Self-Perception Profile for Children,the Individualism-collectivism scale.Results:Binary logistic regression indicated that the stability dimension of cognitive style,the generality dimension of the Cognitive Style Questionnaire,and the social acceptance dimension of the Self-Perception Profile for Children scale were significantly correlated with social support level in male adolescents with subthreshold depression.In contrast,the total score of the Self-Perception Profile for Children scale,the social acceptance of the Self-Perception Profile for Children scale,total individualism,and total collectivism were significantly correlated with social support level in female adolescents with subthreshold depression.Limitations:This study is a cross-sectional study,and its effectiveness in explaining factors that influence levels of social support is limited.Conclusions:The gender difference between low social support among adolescents with subthreshold depression is related to cognitive style,self-perception,and collectivism–individualism.

Not one thing at a time:When concomitant multiple stressors produce a transdiagnostic clinical picture

A condition of exposure to multiple stressors resulting in a mixed clinical picture spanning conventional categories without meeting any of them in full,encompasses a risk for a list of comorbidities preventing appropriate prevention and treatment.New transformative transdiagnostic approaches suggest changes spanning conventional categories.They base their systems of classification on biomarkers as well as on brain structural and functional dysregulation as associated with behavioral and emotional symptoms.These new approaches received critiques for not being specific enough and for suggesting a few biomarkers for psychopathology as a whole.Therefore,they put the value of differential diagnosis at risk of avoiding appropriate derived prevention and treatment.Multiplicity of stressors has been considered mostly during and following catastrophes,without considering the resulting mixed clinical picture and life event concomitant stressors.We herewith suggest a new category within the conventional classification systems:The Complex Stress Reaction Syndrome,for a condition of multiplicity of stressors,which showed a mixed clinical picture for daily life in the post coronavirus disease 2019 era,in the general population.We argue that this condition may be relevant to daily,regular life,across the lifespan,and beyond conditions of catastrophes.We further argue that this condition may worsen without professional care and it may develop into a severe mental health disorder,more costly to health systems and the suffering individuals.Means for derived prevention and treatment are discussed.

Effective treatment of depression improves post-myocardial infarction survival

AIM: To examine the contribution of treatment resistant depression(TRD) to mortality in depressed postmyocardial infarction(MI) patients independent of biological and social predictors.METHODS: This secondary analysis study utilizes the Enhancing Recovery in Coronary Heart Disease(ENRICHD) clinical trial data.From 1834 depressed patients in the ENRICHD study,there were 770 depressed post-MI patients who were treated for depression.In this study,TRD is defined as having a less than 50% reduction in Hamilton Depression(HAM-D) score from baseline and a HAM-D score of greater than 10 in 6 mo after depression treatment began.Cox regression analysis was used to examine the independent contributions of TRD to mortality after controlling for the biological and social predictors.RESULTS: TRD occurred in 13.4%(n = 103) of the 770 patients treated for depression.Patients with TRD were significantly younger in age(P = 0.04)(mean = 57.0 years,SD = 11.7) than those without TRD(mean = 59.2 years,SD = 12.0).There was a significantly higher percentage of females with TRD(57.3%) compared to females without TRD(47.4%) [χ2(1) = 4.65,P = 0.031].There were significantly more current smokers with TRD(44.7%) than without TRD(33.0%) [χ2(1) = 7.34,P = 0.007].There were no significant differences in diabetes(P = 0.120),history of heart failure(P = 0.258),prior MI(P = 0.524),and prior stroke(P = 0.180) between patients with TRD and those without TRD.Mortality was 13%(n = 13) in patients with TRD and 7%(n = 49) in patients without TRD,with a mean follow-up of 29 mo(18 mo minimum and maximum of 4.5 years).TRD was a significant independent predictor of mortality(HR =1.995; 95%CI: 1.011-3.938,P = 0.046) after controlling for age(HR = 1.036; 95%CI: 1.011-1.061,P = 0.004),diabetes(HR = 2.912; 95%CI: 1.638-5.180,P < 0.001),heart failure(HR = 2.736; 95%CI: 1.551-4.827,P = 0.001),and smoking(HR = 0.502; 95%CI: 0.228-1.105,P = 0.087).CONCLUSION: The analysis of TRD in the ENRICHD study shows that the effective treatment of depression reduced mortality in depressed post-MI patients.It is important to monitor the effectiveness of depression treatment and change treatments if necessary to reduce depression and improve cardiac outcomes in depressed post-MI patients.

Treating comorbid anxiety and depression: Psychosocial and pharmacological approaches

Comorbid anxiety with depression predicts poor outcomes with a higher percentage of treatment resistance than either disorder occurring alone. Overlap of anxiety and depression complicates diagnosis and renders treatment challenging. A vital step in treatment of such comorbidity is careful and comprehensive diagnostic assessment. We attempt to explain various psychosocial and pharmacological approaches for treatment of comorbid anxiety and depression. For the psychosocial component, we focus only on generalized anxiety disorder based on the following theoretical models:(1) "the avoidance model";(2) "the intolerance of uncertainty model";(3) "the meta-cognitive model";(4) "the emotion dysregulation model"; and(5) "the acceptance based model". For depression, the following theoretical models are explicated:(1) "the cognitive model";(2) "the behavioral activation model"; and(3) "the interpersonal model". Integration of these approaches is suggested. The treatment of comorbid anxiety and depression necessitates specific psychopharmacological adjustments as compared to treating either condition alone. Serotonin reuptake inhibitors are considered first-line treatment in uncomplicated depression comorbid with a spectrum of anxiety disorders. Short-acting benzodiazepines(BZDs) are an important "bridging strategy" to address an acute anxiety component. In patients with comorbid substance abuse, avoidance of BZDs is recommended and we advise using an atypical antipsychotic in lieu of BZDs. For mixed anxiety and depression comorbid with bipolar disorder, we recommend augmentation of an antidepressant with either lamotrigine or an atypical agent. Combination and augmentation therapies in the treatment of comorbid conditions vis-à-vis monotherapy may be necessary for positive outcomes. Combination therapy with tricyclic antidepressants, gabapentin and selective serotonin/norepinephrine reuptake inhibitors(e.g., duloxetine) are specifically useful for comorbid chronic pain syndromes. Aripiprazole, quetiapine, risperidone and other novel atypical agents may be effective as augmentations. For treatment-resistant patients, we recommend a "stacking approach" not dissimilar from treatment of hypertension In conclusion, we delineate a comprehensive approach comprising integration of various psychosocial approaches and incremental pharmacological interventions entailing bridging strategies, augmentation therapies and ultimately stacking approaches towards effectively treating comorbid anxiety and depression.

Theory of mind deficits in patients with esophageal cancer combined with depression

AIM:To characterize the two components of theory of mind(ToM) in patients with esophageal cancer combined with depression.METHODS:Sixty-five patients with esophageal cancer combined with depression(depressed group) and 62 normal controls(control group) were assessed using reading the mind in the eyes test,faux pas task,verbal fluency test,digit span test and WAIS IQ test.The depressed group was divided into two subgroups including psychotic depressed(PD) group(32 cases) and nonpsychotic depressed(NPD) group(33 cases).The clinical symptoms of patients were assessed using Beck depression inventory version Ⅱ and brief psychiatric reacting scale(BPRS).RESULTS:There was a significant difference between the depressed group and the control group on tasks involving ToM social perceptual components(mind reading:t = 7.39,P < 0.01) and tests involving ToM social cognitive components(faux pas questions:t = 13.75,P < 0.01),respectively.A significant difference was also found among the PD group,the NPD group and the control group on mind reading(F = 32.98,P < 0.01) and faux pas questions(χ 2 = 78.15,P < 0.01),respectively.The PD group and NPD group performed worse than normal group controls both on mind reading and faux pas questions(P < 0.05).The PD group performed significantly worse than the NPD group on tasks involving ToM(mind reading:F = 18.99,P < 0.01;faux pas questions:F = 36.01,P < 0.01).In the depressed group,there was a negative correlation between ToM performances and BPRS total score(mind reading:r =-0.35,P < 0.01;faux pas questions:r =-0.51,P < 0.01),and between ToM performances and hostile suspiciousness factor score(mind reading:r =-0.75,P < 0.01;faux pas questions:r =-0.73,P < 0.01),respectively.CONCLUSION:The two components of ToM are both impaired in patients with esophageal cancer combined with depression.This indicates that there may be an association between ToM deficits and psychotic symptoms in clinical depression.

Relationships between cognitive emotion regulation strategies with depression and anxiety

In current study firstly, psychometric properties of Cognitive Emotion Regulation Questionnaire (CERQ) in an Iranian sample were examined. The result of factor analysis, subscales correlations, internal consistency and test-retest coefficients showed good psychometric properties of CERQ in Iran. Secondly, relationships between cognitive emotion regulation strategies with depression and anxiety were studied by multiple regression analysis. The result showed that catastrophizing, self-blame and rumination were related with high level of anxiety and depression and refocusing, positive reappraisal and planning subscales related with low level of anxiety and depression.

Effect of cognitive behavioral therapy on anxiety and depression of infertile women: A meta-analysis

Objective:To investigate the effect of cognitive behavioral therapy on anxiety and depression in infertile women.Methods:This study was performed in 2019 by searching Google Scholar,Scopus,PubMed/MEDLINE,Cochrane library,EMBASE,Proquest,ISI Web of Science,MagIran,SID and IranMedex.Eligible studies were selected by two reviewers and outcomes of interest were extracted.The meta-analysis was performed using the random effect models.Ⅰ-square statistic test was used for heterogeneity analysis.Presence of publication bias was also checked.Results:Eleven studies were included in this review.Between-group differences(cognitive behavioral therapy and control groups)in risk ratio for infertile women's depression was d=-1.36;95%CI=-1.81,-0.90;P<0.001.For infertile women's anxiety,between-group differences in risk ratio wasd=-0.83;95%CI=-1.18,-0.47;P<0.001.Conclusions:Cognitive behavioral therapy is effective in the reduction of depression and anxiety in patients with or withoutin vitro fertilization/intracytoplasmic sperm injection treatment.However,the lack of high-quality studies makes it challenging to make a solid and precise conclusion.Well-designed studies should be undertaken in the future to confirm these results.

Effects of Religious vs. Conventional Cognitive-Behavioral Therapy on Inflammatory Markers and Stress Hormones in Major Depression and Chronic Medical Illness: A Randomized Clinical Trial

Background: Depressive disorder is often accompanied by physiological changes that may adversely affect the course of medical illness, including an increase in pro-inflammatory cytokines. Methods: We examine the effects of religious cognitive behavioral therapy (RCBT) vs. conventional CBT (CCBT) on pro-/anti-inflammatory indicators and stress hormones in 132 individuals with major depressive disorder (MDD) and chronic medical illness who were recruited into a multi-site randomized clinical trial. Biomarkers (C-reactive protein and pro-inflammatory cytokines TNF-α, IL-1β, IFN-γ, IL-6, IL-12-p70), anti-inflammatory cytokines (IL1ra, IL-4, IL-10), and stress hormones (urinary cortisol, epinephrine, norepinephrine) were assessed at baseline, 12 weeks, and 24 weeks. Differential effects of baseline religiosity on treatment response were also examined, along with effects of religiosity on changes in biomarkers over time independent of treatment group. Biomarker levels were log transformed where possible to normalize distributions. Mixed models were used to examine trajectories of change. Results: CRP increased and IL-4, IL-10, and epinephrine decreased over time, mostly in the opposite direction expected (except epinephrine). No significant difference between RCBT and CCBT was found on average trajectory of change in any biomarkers. Religiosity interacted with treatment group in effects on IL-6, such that CCBT was more effective than RCBT in lowering lL-6 in those with low religiosity whereas RCBT appeared to be more effective than CCBT in those with high religiosity. Higher baseline religiosity also tended to predict an increase in pro-inflammatory cytokines INF-γ and IL-12 (p70) and urinary cortisol over time. Conclusions: RCBT and CCBT had similar effects on stress biomarkers. CCBT was more effective in reducing IL-6 levels in those with low religiosity, whereas RCBT tended to be more effective in those with high religiosity. Unexpectedly, higher baseline religiosity was associated with an increase in several stress biomarkers.

Treatment outcomes and cognitive function following electroconvulsive therapy in patients with severe depression

BACKGROUND Traditional treatments for major depressive disorder(MDD),including medication and therapy,often fail and have undesirable side effects.Electroconvulsive therapy(ECT)uses electrical currents to induce brief seizures in the brain,resulting in rapid and potent antidepressant effects.However,owing to misconceptions and controversies,ECT is not as widely used as it could and often faces stigmatization.AIM To evaluate the efficacy and safety of ECT compared to those of medication and/or therapy in patients with severe MDD.METHODS This prospective cohort study included 220 individuals with severe MDD who were divided into the ECT and non-ECT groups.The patients in the ECT group underwent bilateral ECT three times a wk until they either achieved remission or reached a maximum of 12 sessions.The non-ECT group received medication and/or therapy according to clinical guidelines for MDD.The primary outcome was the variation in the hamilton depression rating scale(HDRS)score from treatment/ECT initiation to week 12.In addition,patients’quality of life,cognitive abilities,and biomarkers were measured throughout the study.RESULTS Although both groups showed significant improvements in their HDRS scores over time,the improvement was more pronounced in the ECT group than in the non-ECT group.Additionally,the ECT group exhibited a more substantial improvement in the quality of life and cognitive function than those of the non-ECT group.Compared with the non-ECT group,the ECT group exhibited evidently lower variations in the brain-derived neurotrophic factor(BDNF)and cytokine interleukin-6(IL-6)levels.The side effects were generally mild and comparable between the two groups.ECT is safer and more potent than medication and/or therapy in mitigating depressive symptoms,enhancing wellbeing,and bolstering cognitive capabilities in individuals with severe MDD.ECT may also affect the levels of BDNF and IL-6,which are indicators of neuroplasticity and inflammation,respectively.CONCLUSION ECT has emerged as a potentially advantageous therapeutic approach for patients with MDD who are unresponsive to alternative treatments.

Effect of escitalopram on cognitive function in depressionA mismatch negativity potentials study

We detected the event-related potential mismatch negativity （MMN） of 30 depression patients and compared to 30 age,gender,and education-matched healthy controls.Results showed that amplitudes of frequency and duration MMN were lower in depression patients compared with control patients,indicating abnormality in auditory processing （i.e.,cognitive impairment）.Following escitalopram treatment for 8 weeks,the amplitudes of frequency and duration MMN were significantly increased and Hamilton Rating Scale for Depression scores were significantly decreased in depression patients.These data suggest that escitalopram can improve cognitive function of patients with depression.Further,MMN may be a useful tool for evaluating cognitive function and treatment effects.

Effect and mechanism of LW-AFC on chronic unpredictable mild stress-induced mood and cognition impairment of mice

OBJECTIVE To explore the effect and mechanisms of LW-AFC,a new formula derived fromLiuwei Dihuang decoction,on chronic unpredictable mild stress(CUMS)-induced mood and cogni.tion impairment in mice.METHODS C57 BL/6 J mice were randomly placed into seven groups(n=10):normal control group,CUMS group,Fluoxetine(10 mg·kg^(-1),once per day) group,Liuwei Dihuang decoction group(LW,10 g·kg^(-1),once per day),and LW-AFC(0.8 g·kg^(-1),1.6 g·kg^(-1),3.2 g·kg^(-1),once per day) group.The stressed group was given CUMS for 4 weeks to set up a chronic multiple-stressed model.LW and LW-AFC was oral administered a week prior to CUMS and until the end of the study(a total of 35 d),while fluoxetine was administrated orally for 4 weeks.The anxiety behavior was analyzed using the open field test(OFT) and elevated plus maze test(EPM).The depression behavior was ana.lyzed using the sucrose preference test(SPT) and forced swimming test(FST).Spatial cognition was evaluated using Morris water maze(MWM) test and working memory was evaluated using new object recognition test(NORT).RESULTS CUMS for 28 d increased depressive-and anxiety-like behaviors.LW-AFC(1.6 g·kg^(-1)) significantly increased the numbers of entries into the open arm and time in the open arm of CUMS mice(P<0.05).LW-AFC(3.2 g·kg^(-1)) increased sucrose consumption and de.creased the immobility time of FST(P<0.01) of CUMS mice.The MWM test showed that spatial learning andmemory in CUMS mice were remarkably affected relative to controls,whereas LW-AFC(3.2 g·kg^(-1)) im.proves cognitive functions(P<0.05).CONCLUSION The mood and theability of learning and memory of thestressed group can be affected after exposure to CUS.Oral administration of LW-AFC significant.ly improved CUMS-induced impairments of mood and cognition in mice.

Cognitive Effects of Late Life Depression: Review of Neuropsychological Findings

Normal aging and depression both slow information processing speed which leads to poorer attentional control, shallower inhibition monitoring, poorer encoding, poorer updating of short term memory, and subsequent poorer learning, set-shifting, error monitoring, inhibition control, and cognitive planning. A combination of aging and depression amplifies these cognitive effects. Deterioration in frontal brain functioning in normal aging is irreversible, but altering of frontal brain function due to depression may be reversible. Since the symptoms are indistinguishable, it is difficult to separate effects of depression and aging with use of neuropsychological tests, even when premorbid history is known. Statistical group effects show more severe cognitive effects in late life depression than in normal aging or depression in younger persons, but no particular cognitive markers of depression in older subjects have been identified. Attention and inhibition are closely related, but their relationship needs to be studied further. It is not clear, whether a problem with inhibition of irrelevant stimuli occurs because of attentional deficits due to late life depression, or if it is a primary consequence of the depression. Further studies on the relationship between inhibition, attention and processing speed involving homogeneous depressed and non-depressed groups of different age may help disentangle this relationship.