Highlights of three new studies involving geriatric psychiatry include: older adults who carry the apolipoprotein E4 (APOE4) genotype can reap the cognitive benefits of healthy lifestyle changes; personality changes during the transition from cognitive health to mild cognitive impairment (MCI) occur early on during the development of Alzheimer disease; and metabolic syndrome in depressed older adults affects their response to antidepressant treatment.
Healthy lifestyle changes may be beneficial for cognition in older, at-risk individuals even in the presence of APOE4–related genetic susceptibility to dementia. A randomized clinical trial in 6 centers, The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability, included 1109 participants, mean age 69.3 years; 362 were APOE ε4 allele carriers (173 intervention and 189 control) and 747 were non-carriers (380 intervention and 367 control).
The cognitive benefits of a 2-year, multipronged intervention targeting diet, exercise, cognitive training and vascular risk factors did not significantly differ between APOE4 ε4 allele carriers and non-carriers.
Clinical Implications for Study 1: “Whether such benefits are more pronounced in APOE ε4 carriers compared with non-carriers should be further investigated. The findings also emphasize the importance of early prevention strategies that target multiple modifiable risk factors simultaneously,” stated the researchers, led by Alina Solomon, MD, PhD, from the Institute of Clinical Medicine/Neurology, University of Eastern Finland in Kuopio.
Personality changes begin during the transition from preclinical Alzheimer disease to mild cognitive impairment and resemble the clinical behavioral disorders that arise in those with dementia. A study included 277 neuropsychiatrically healthy people predisposed to APOE ɛ4 genetically. After longitudinal observations for more than 7 years, 25 people developed MCI and were compared with the 252 non-transitioners. All participants had medical and neurological (or brain) exams, and were also screened for depression, as well as cognitive and physical function.
The results show changes in personality, including increasing neuroticism and decreasing openness, coincided with the transition from preclinical Alzheimer’s disease to MCI, with concomitant subclinical changes in behavioral measures of somatization, depression, anxiety, irritability and aggression.
Clinical Implications for Study 2: With further research, “earlier identification of predisposing personality changes might facilitate earlier, safer, more effective treatment or even prevention of behavioral disorders in individuals with Alzheimer’s disease,” stated the researchers, led by Richard J. Caselli, MD, of the Mayo Clinic Arizona.
Metabolic syndrome leads to decreased rates of remission from depression in older adults who are treated pharmacologically. A secondary analysis of a randomized controlled trial set in three academic medical centers in North America included 435 adults, mean age 69.1 years, with major depressive disorder. They were treated with extended-release venlafaxine for 12 or more weeks. Half of the patients met criteria for metabolic syndrome at baseline; those with metabolic syndrome had greater severity and chronicity of depression.
Remission was achieved in 182 participants (42%). In an unadjusted analysis, metabolic syndrome was associated with prolonged time to remission, but this relationship was not significant in the adjusted model.
Clinical Implications for Study 3: Poorer antidepressant response observed in those with metabolic syndrome accounts for the greater symptom severity and chronicity of depression. The results suggest that older adults with metabolic syndrome may be an important group for clinicians to pay close attention to when screening for and treating depression.