Phenotype Predictors of Cognitive Outcomes in Geriatric Depression
Trial Snapshot
- Phase
- Phase 4
- Status
- Active, not recruiting
- Sponsor
- Enrollment
- 75
- Locations
- 2
- Primary Endpoint
- Cognitive clinical diagnosis
Study Overview
Brief Summary
This study will focus on examining effects of stress on long-term mood and cognitive outcomes of late-life depression. It will also example the neural underpinnings of these changes using structural and functional brain imaging. Understanding how effects of stress in older depressed adults, as well as factors that might minimize those effects, lead to particular mood and cognitive outcomes will inform future development of novel prevention strategies.
Detailed Description
In this renewal of R01MH108578, the investigators are seeking to extend findings from the initial study to focus on effects of stress in longitudinal mood and cognitive outcomes of late-life depression (LLD) and to examine stress effects on brain structure and function in LLD. Severe or persistent stressors can result in a number of behavioral and mood changes, including anxiety, dysphoric mood, sleep disruption, altered appetite, and withdrawal from social and pleasurable activities. These stress-related consequences are particularly salient when considering longitudinal outcomes of treated LLD. They may be compounded by an individual's longstanding maladaptive patterns of response to stress, embodied in the construct of neuroticism, which the investigators have shown to be related to poor mood and cognitive LLD outcomes. Moreover, Andreescu et al. (2019) introduced a model of depression recurrence that incorporates the homeostatic disequilibrium hypothesis, which proposes that in geriatric remitted depression, neural networks are in fragile homeostasis that is threatened by stress exposure. Networks of particular importance in stress of LLD outcome are the Default Mode Network (DMN), Salience Network (SN) and Executive Control Network (ECN).
The Neurobiology of Late Life Depression (NBOLD) study began enrolling older depressed and never depressed controls in 2013, enrolling 132 depressed and 44 controls, and currently follows 77 depressed and 22 controls. Subjects are well characterized in terms of mood, cognition, personality and stress (including specific measures obtained during the present COVID pandemic). It is well suited to examine stress effects on longitudinal mood and cognitive outcomes. For the renewal, the study will follow current subjects and recruit 75 new subjects, who will be followed for up to 5 years with annual cognitive testing, stress measures and baseline and two-year functional brain magnetic resonance imaging (fMRI) scan.
In this renewal, the investigators will examine the following specific aims:
- To study effects of stressors (obtained on a variety of measures) and neuroticism on longitudinal mood and cognitive outcomes in older adults with history of major depressive disorder (MDD).
- To study effects of stress and neuroticism on brain structure and function in older adults with MDD history.
- To explore relationships among variables in Aims 1 and 2 with longitudinal multivariable statistical models.
Study Design
- Study Type
- Interventional
- Allocation
- Na
- Intervention Model
- Single Group
- Primary Purpose
- Other
- Masking
- None
Eligibility Criteria
- Ages
- 65 Years to — (Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •major depression, single episode or recurrent;
- •ability to read and write English;
- •Mini-Mental State Examination >25.
Exclusion Criteria
- •lifetime alcohol/drug dependence
- •conditions associated with brain abnormalities such hydrocephalus, benign and cancerous brain tumors, epilepsy, Parkinson's disease, Huntington's chorea, dementia, demyelinating diseases, etc.
- •untreated endocrine disorder other than diabetes mellitus
- •established clinical diagnosis of dementia
- •other primary psychiatric disorders, e.g., panic disorder, social phobia, obsessive- compulsive disorder, schizoaffective disorder, schizophrenia, bipolar disorder
Arms & Interventions
Depressed
Subjects receive FDA-approved antidepressants
Intervention: Sertraline, bupropion, desvenlafaxine (Drug)
Outcomes
Primary Outcomes
Cognitive clinical diagnosis
Time Frame: three years
Participant records will be reviewed annually by the consensus panel. The study will convene a panel of experts to review each case, including the PI, treating geriatric psychiatrists and study neuropsychologist. Panel members review the following information for each participant: 1) initial evaluation and most recent clinical depression study notes, 2) neuropsychological testing profiles, 3) informant report of cognitive decline based on the Dementia Severity Rating Scale, 4) study structural MRI images to determine vascular burden, and 5) additional neurological and clinical neuropsychological consultations when available. The panel discusses the case until a consensus cognitive diagnosis is reached.
Montgomery-Asberg Depression Rating Scale (MADRAS)
Time Frame: Three years
Measure of depression severity and Recurrence of Depression Minimum Score = 0; Maximum Score = 60; Higher score means worse outcome
Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Neuropsychological Battery Total Score
Time Frame: Three years
Global cognitive measure; Minimum Score = 0; Maximum Score = 100; Higher score means better outcome
Secondary Outcomes
- Functional brain magnetic resonance imaging (fMRI) scan structural imaging changes(Two years)
- Functional brain magnetic resonance imaging (fMRI) scan changes in resting state functional connectivity.(Two years)
Investigators
David Steffens
Samuel "Sy" Birnbaum/Ida, Louis and Richard Blum Chair in Psychiatry Professor and Chair, Department of Psychiatry
UConn Health