depression. And anxiety are associated with early onset Alzheimer’s disease (AD), a new study shows.
Researchers found that the age of onset of AD was about two years earlier in patients with depression and three years earlier in patients without these disorders in anxious patients. In addition, having multiple psychiatric diagnoses makes the age of AD onset even earlier.
The findings underscore the importance of screening for cognitive decline in older patients, including those with psychiatric status, said study author Zachary A. Miller, Ph.D., Neurology, University of California, San Francisco Memory and Aging Center. The associate professor said. Medscape Medical News..
“As part of healthy aging, I think we need to do some screening for cognition, just as everyone needs to get. Colon endoscopy At the age of fifty. “
If you have symptoms of depression or anxiety, or if they are not well treated, and if you have cognitive complaints in addition to psychiatric and mood concerns, we are definitely who they are. I want to know if I need to monitor the patient.
The findings will be presented at the 2021 Annual Meeting of the American Academy of Neurology (AAN) in April.
Dose-dependent effect?
Researchers have established that depression is a risk factor that can accelerate the onset of AD and the course of the disease.But they have other mood disorders, mental disorders, and Post-traumatic stress disorder (PTSD) AD.
To investigate, researchers screened 1500 patients with AD from the UCSF Memory and Aging Center for a history of various mental states.The results showed that 43.3% of the subjects had a history of depression, 32.3% anxiety, and 1.2%. Bipolar disorder, 1% PTSD, and 0.4% schizophrenia..
Participants in these conditions were significantly younger at the age of onset of AD than those without depression or anxiety (2.1 and 3.0 years, respectively). P <.001).
Miller said the patient “ran the entire range” of the symptoms of depression, but was “very similar” with respect to the age of onset of AD, with or without a formal diagnosis of depression.
Researchers looked at when patients first showed symptoms of depression before the onset of AD (within 2 years, 2-10 years, or more than 10 years). Again, when it comes to early onset of AD, “it didn’t matter when the psychiatric symptoms appeared,” Miller said.
The age difference at the onset of AD doubled with each additional psychiatric diagnosis. The presence of only one psychiatric disorder was associated with a young age of 1.5 years, two mental states were associated with a young age of 3.3 years, and three or more diagnoses were associated with a young age of 7.3 years ()P <.001).
“The symptomatological profile of individuals who develop AD at a younger age has more of these psychiatric features, and the more features and intensities of those features have found that the age of onset is younger. “Miller said.
He said that the two mental states groups “almost exclusively include only those with anxiety and depressive symptoms,” and the groups with three or more states were primarily PTSD groups, with depression and anxiety. Stated.
More questions than answers?
Behavioral neurologist Miller said there are several ways to interpret the data.
“When AD begins, it attacks or begins very early in the lower, midbrain, and brainstem regions of the brain, and some of the earliest pathological manifestations of AD are actually prodromal symptoms of depression. We think it could be something like this, but having a history of depression can put a strain on the same area and make patients more susceptible to AD. “
Researchers have gone deeper to better understand what is causing the early onset of AD in patients with mental illness.They examined demographics and typical risk factors for AD, including: High blood pressure, Hyperlipidemia, diabetes, education and APOE4..
They found that the cohort of depression and anxiety included more women. This may suggest that women with AD “have a strong tendency to exhibit depression and anxiety as early features.”
These participants also had lower risk factors for typical AD. Miller said they were unlikely to have cardiovascular and cerebrovascular risk factors because they were young.
Researchers also looked at what Miller called a “new” factor associated with AD. This includes autoimmune diseases such as: Type 1 diabetes, Multiple sclerosis, History of seizures, etc.
“Many people with depression happened to have a statistically significant number of autoimmune diseases, so many had a history of autoimmune diseases,” Miller said.The· P The value associated with depression and autoimmune disease was 0.01.
Neuroinflammation can play a role in the association between depression and early onset of AD. Miller said many studies are investigating inflammation as a possible root cause of depression.
The direction of the relationship is not clear, but “my bias is that some systemic inflammation crosses the brain and affects certain areas, so you may appear depressed. “Miller said.
The study also showed that participants with anxiety had a higher frequency of seizures (P = .002). Miller pointed out several previous studies suggesting an association between seizures and anxiety. This is probably the underlying pathophysiological mechanism associated with neuronal hyperexcitability.
Researchers did not see the role of psychiatric drugs. Miller said it would be “great” to “examine the vertical area” to determine how treatment or non-treatment is associated with disease progression.
He admitted that the study did not fully explain why patients with mental states were more vulnerable to early onset of AD. “In the end, it probably raises more questions than it provides an answer, but hopefully it creates interest and excitement.”
“Welcome Addition”
Comments on this study Medscape Medical NewsDr. John C. Morris, MD, professor of neurology at Washington University in St. Louis, Missouri, and director of the Alzheimer’s Disease Research Center, welcomes additional information on “possible relationships” between depression and dementia, especially AD. “.
The strength of this study was that the author was not just focusing on depression, but also considering other mental states, said Morris, who was not involved in the study. However, he said PTSD, bipolar disorder, and schizophrenia were “too rare to analyze.”
Morris pointed out some “warnings” to research that might be addressed during a presentation at the AAN conference.
First, patients with depression who come to the center of memory and aging usually have very mild depressive traits called “subsymptomatological depression” or SSD. According to Morris, such patients are not eligible to be diagnosed with a major affective disorder.
He said he would like to know more about the severity of the participants labeled “depression” and “anxiety.”
In addition, it is unclear whether patients with depression and anxiety came to the UCSF Center with memory concerns 1-3 years earlier than those who did not report depression and anxiety. “Probably AD dementia began at about the same age in both groups, but the’depression’group sought a diagnosis earlier,” Morris said.
Another caveat is that the analysis did not consider the potential effects of drugs used to treat depression and anxiety. This may have worsened your memory and thoughts.
“Perhaps it wasn’t the mental illness itself that caused the young age observed at the time of onset, but instead the drugs used to treat the disorder,” Morris said...
he Cite research Provides “very preliminary evidence” of common antidepressants EscitalopramSelective serotonin reuptake inhibitors may benefit people at risk for AD dementia by reducing the amount of cerebrospinal fluid and perhaps the characteristic Alzheimer protein amyloid beta 42 in the brain. ..
Morris agreed that the nature of the possible association between depression and dementia, especially AD dementia, is “still controversial.”
This study was supported by the National Institute on Aging .. Miller and Morris do not disclose the relevant financial relationship.
American Academy of Neurology (AAN) 2021 Annual Meeting: Presentation 003, to be announced on April 20, 2021.
