Drugs that target glutamate neuronal transmission, such as memantine, offer a novel approach to the treatment of late-life depression, which is frequently comorbid with cognitive impairment. The ...results of our recently published double-blind, randomized, placebo-controlled trial of escitalopram or escitalopram/memantine in late-life depression with subjective memory complaints (NCT01902004) indicated no differences between treatments in depression remission, but additional benefits in cognition at 12-month follow-up with combination treatment. To identify pathways and biological functions uniquely induced by combination treatment that may explain cognitive improvements, we generated transcriptional profiles of remission compared with non-remission from whole blood samples. Remitters to escitalopram compared with escitalopram/memantine combination treatment display unique patterns of gene expression at baseline and 6 months after treatment initiation. Functional enrichment analysis demonstrates that escitalopram-based remission associates to functions related to cellular proliferation, apoptosis, and inflammatory response. Escitalopram/memantine-based remission, however, is characterized by processes related to cellular clearance, metabolism, and cytoskeletal dynamics. Both treatments modulate inflammatory responses, albeit via different effector pathways. Additional research is needed to understand the implications of these results in explaining the observed superior effects of combination treatment on cognition observed with prolonged treatment.
Purpose of Review
A growing body of research supports the use of mind-body therapies (MBTs) as minimally invasive and effective approaches for the management of late-life mood and cognitive ...disorders.
Recent Findings
Recent randomized controlled trials and meta-analyses indicate that MBTs are effective for enhancing well-being, mood, sleep, and cognition in older adults. Evidence suggests that mindful movement (e.g., yoga, tai chi, walking meditation) may even outperform conventional physical exercise with regard to effects on quality of life, mood, and cognitive functioning.
Summary
Practitioners may recommend MBTs as holistic, effective approaches for the management of common late-life mood and cognitive disorders. Continued research on MBTs will inform the development of even more effective/targeted interventions and contribute to greater acceptance and integration of these therapies into geriatric medicine and psychiatry.
Stress, inflammation, and aging Lavretsky, Helen; Newhouse, Paul A
The American journal of geriatric psychiatry,
09/2012, Letnik:
20, Številka:
9
Journal Article
Background
Yoga may produce positive effects on cognitive functions in older adults at risk for cognitive decline. In this study (NCT03503669), we investigated neural and peripheral biomarkers ...therapeutic response in older women with subjective cognitive decline (SCD) and cerebrovascular risk factors (CVRFs) following three months of yoga compared to memory enhancement training (MET).
Method
We conducted a randomized, controlled trial to assess the efficacy of Kundalini yoga (YOGA) and memory enhancement training (MET) on mood and cognitive functioning in a group of older women with CVRFs and SCD. RNA sequencing and cytokine/chemokine assays were analyzed as well as a multimodal MRI (Siemens 3T Prisma scanner).
Result
A total of 79 patients (YOGA = 40; MET = 39) were randomized and 63 completed the 24‐week follow‐up (Mean age = 66.5 years and mean MMSE was 28.4). At 12‐weeks and 24‐weeks, both interventions demonstrated improvement in frequency of forgetting (MFQ‐Factor 1) (F(1, 76) = 0.2, p = 0.7). At 24‐weeks, YOGA participants demonstrated between‐ and within‐groups improvements in seriousness of forgetting/MFQ‐Factor 2 (effect size (95% confidence interval) = ‐0.73 (‐1.26, ‐0.19)). Compared to MET, at 12‐ and 24‐weeks follow‐up, YOGA uniquely modulated targets related to interferon signaling and innate and adaptive immunity. Compared to YOGA, MET participants displayed higher Eotaxin‐1 levels (F(2,67) = 3.94, p = 0.02). On sMRI‐Compared to KY + KK, MET showed reductions in GMV in left prefrontal, pre‐ and post‐central, supramarginal, superior temporal and pericalcarine cortices, right paracentral, postcentral, superior and inferior parietal cortices. Right hippocampal volume increased after yoga. rs‐fMRI analysis showed a left anterior hippocampal subregion assigned to the default mode network (DMN) with greater increases in connectivity with largely ventral visual stream regions with YOGA than with MET (p<.001), in associations with lower stress (p<.05).
Conclusion
At 24‐weeks follow‐up, YOGA yielded a significant, large effect size improvement in subjective cognitive impairment, and a robust mediation of inflammatory‐immune pathways, including suppression of pro‐inflammatory molecules. YOGA also offered neuroprotective effects compared to MET. These results suggest clinical, neural and biological benefits to YOGA for SCD in post‐menopausal women at risk for AD.
ABSTRACTBackground:Traditional perspectives conceptualize resilience as a trait and depression as resulting from resilience deficiency. However, research indicates that resilience varies ...substantially even among adults who are clinically depressed, as well as across the lifespan of an individual. Few studies have investigated resilience in depression, and even fewer have examined resilience in depressed older adults.
Three hundred thirty-seven adults ≥60 years with major depressive disorder completed the Connor-Davidson Resilience Scale (CD-RISC) and measures of mental health, quality of life (QOL), and medical comorbidity. Exploratory factor analysis was used to explore the factor structure of the CD-RISC. Correlations and general linear models were used to examine associations between resilience and other variables.
The rotated component matrix indicated a four-factor model. Sorting of items by highest factor loading revealed constructs associated with (1) grit, (2) active coping self-efficacy, (3) accommodative coping self-efficacy, and (4) spirituality. Resilience was significantly correlated with increased age, lower cognitive functioning, greater cerebrovascular risk, and greater medical comorbidity. Resilience was negatively associated with mental health symptoms (depression, apathy, and anxiety) and positively associated with QOL. The final optimal model identified less depression, less apathy, greater medical comorbidity, higher QOL, and minority (non-White) race as factors that significantly explained variability in resilience.
Resilience was significantly associated with a range of mental health constructs in a sample of older adults with depression. Future clinical trials and dismantling studies may help determine whether interventions targeting grit, active coping, accommodative coping, and spirituality can increase resilience and help prevent and treat depression in older adults.
Global population aging will result in increasing rates of cognitive decline and dementia. Thus, effective, low-cost, and low side-effect interventions for the treatment and prevention of cognitive ...decline are urgently needed. Our study is the first to investigate the effects of Kundalini yoga (KY) training on mild cognitive impairment (MCI).
Older participants (≥55 years of age) with MCI were randomized to either a 12-week KY intervention or memory enhancement training (MET; gold-standard, active control). Cognitive (i.e. memory and executive functioning) and mood (i.e. depression, apathy, and resilience) assessments were administered at baseline, 12 weeks and 24 weeks.
At baseline, 81 participants had no significant baseline group differences in clinical or demographic characteristics. At 12 weeks and 24 weeks, both KY and MET groups showed significant improvement in memory; however, only KY showed significant improvement in executive functioning. Only the KY group showed significant improvement in depressive symptoms and resilience at week 12.
KY group showed short- and long-term improvements in executive functioning as compared to MET, and broader effects on depressed mood and resilience. This observation should be confirmed in future clinical trials of yoga intervention for treatment and prevention of cognitive decline (NCT01983930).
Background
Female sex, subjective cognitive decline (SCD), and cardiovascular risk factors (CVRF) are known risk factors for developing Alzheimer’s disease (AD). We previously demonstrated that yoga ...improved depression, resilience, memory and executive functions, increased hippocampal choline concentrations and modulated brain connectivity in older adults with mild cognitive impairment. In this study (NCT03503669), we investigated brain gray matter volume (GMV) changes in older women with SCD and CVRF following three months of yoga compared to memory training (MET).
Methods
Eleven women (mean age = 61.45, SD = 6.58) with CVRF and SCD completed twelve weeks of Kundalini yoga (KY) and Kirtan Kriya (KK), while eleven women (mean age = 64.55, SD = 6.41) underwent MET. T1‐weighted MRI scans were acquired at baseline and follow‐up using a Siemens 3T Prisma scanner. We used Freesurfer 6 and longitudinal two‐step models to test group differences in symmetrized percent change in GMV. Resulting clusters were corrected and Monte‐Carlo simulations applied at an alpha level of 0.05. Region‐of‐interest analysis was performed for hippocampus and amygdala.
Results
Compared to KY+KK, MET showed reductions in GMV in left prefrontal, pre‐ and post‐central, supramarginal, superior temporal and pericalcarine cortices, right paracentral, postcentral, superior and inferior parietal cortices, the banks of the superior temporal sulcus, and the pars opercularis. Right hippocampal volume increased after yoga but did not survive corrections.
Conclusion
Yoga training may offer neuroprotective effects compared to MET in preventing neurodegenerative changes and cognitive decline, even over short time intervals. Future analyses will address changes in functional connectivity in both groups.
Numerous geriatric patients are using Complementary and Alternative Medicine (CAM) for late-life mood and cognitive disorders. Natural products and supplements are a common CAM intervention which ...have risks and benefits of which patients should be appropriately advised. The data for omega-3 fatty acids, ginkgo biloba, SAMe, St John’s wort, B vitamins and vitamin D, huperzine, caprylidene, and coconut oil will be evaluated. Since the evidence basis for natural products and supplements is limited, especially for the geriatric population, studies involving the general adult population are included to infer effects in the aging population. Despite the data available, more rigorous studies with larger sample sizes over longer periods of time are still needed. Regardless of a physician’s preference to recommend various natural supplements and products, a physician could protect their patients by having an understanding of the side effects and indications for various natural products.
No study has explored the effect of yoga on cognitive decline and resting-state functional connectivity.
This study explored the relationship between performance on memory tests and resting-state ...functional connectivity before and after a yoga intervention versus active control for subjects with mild cognitive impairment (MCI).
Participants ( ≥ 55 y) with MCI were randomized to receive a yoga intervention or active "gold-standard" control (i.e., memory enhancement training (MET)) for 12 weeks. Resting-state functional magnetic resonance imaging was used to map correlations between brain networks and memory performance changes over time. Default mode networks (DMN), language and superior parietal networks were chosen as networks of interest to analyze the association with changes in verbal and visuospatial memory performance.
Fourteen yoga and 11 MET participants completed the study. The yoga group demonstrated a statistically significant improvement in depression and visuospatial memory. We observed improved verbal memory performance correlated with increased connectivity between the DMN and frontal medial cortex, pregenual anterior cingulate cortex, right middle frontal cortex, posterior cingulate cortex, and left lateral occipital cortex. Improved verbal memory performance positively correlated with increased connectivity between the language processing network and the left inferior frontal gyrus. Improved visuospatial memory performance correlated inversely with connectivity between the superior parietal network and the medial parietal cortex.
Yoga may be as effective as MET in improving functional connectivity in relation to verbal memory performance. These findings should be confirmed in larger prospective studies.
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