- Email: [email protected]
EXERCISE AS AN AUGMENTATION TO PHARMACOTHERAPY FOR DEPRESSION IN OLDER AND YOUNGER ADULTS: A FEASIBILITY TRIAL EXPLORING BIOLOGICAL MECHANISMS
AAGP Annual Meeting 2019 The findings from these interviews illuminate the need for greater attention and support for FTD caregivers by knowledgeable care providers. This research was funded by: Not applicable.
Poster Number: EI - 30
ASSOCIATION BETWEEN WHITE MATTER HYPERINTENSITIES, FRONTAL BRAIN VOLUMES AND NEUROTICISM IN LATE LIFE DEPRESSION Chinaka Joseph; Lihong Wang; Kevin Manning; Rong Wu; David Steffens University of Connecticut School of Medicine Introduction: The neurobiology of neuroticism in late life depression (LLD) is understudied. Previous structural imaging research has linked both smaller hippocampal volumes and greater volume of vascular white matter changes to LLD. We hypothesized older depressed subjects scoring high in measures of neuroticism would have smaller hippocampal volumes compared with non-neurotic older depressed subjects and with non-depressed controls. Methods: Non-demented subjects were recruited and were either depressed with high neuroticism, depressed with low neuroticism or not depressed (control). Neuroticism was assessed using the NEO PI. A study psychiatrist confirmed or ruled out diagnosis of depression for depressed and control subjects. Brain MRIs were performed. Results: The study sample consisted of 128 older depressed subjects and 36 never depressed controls. Subjects had a mean age of 72 and were 70% female. 50% of depressed subjects scored high on the NEO-PI neuroticism measure. For outcomes focusing on white matter changes, we found that non-neurotic depressed subjects had a higher volume of white matter vascular change than did neurotic depressed subjects and non-depressed controls. For imaging outcomes focused on volumetric analyses, we several frontal lobe regions for which depressed subjects with high neuroticism scores had smaller volumes compared with non-neurotic older depressed subjects and with non-depressed controls, controlling for age and gender. These regions included frontal pole, medial orbitofrontal cortex and left pars orbitalis. We did not find significant between-group differences in hippocampal volume. Conclusions: In late-life depression hippocampal volume was not associated with depression or neuroticism. Our finding that those depressed subjects low in neuroticism had higher white matter vascular change volumes is consistent with prior literature on “vascular depression.” However, our finding that those high in neuroticism had similar white matter vascular change to controls implies that there may be a different neurobiological mechanism in older neurotic depressed group. This notion is supported by our finding that several frontal lobe structures were smaller in patients who scored high in measures of neuroticism than in non-neurodepressed subjects and in non-depressed controls. Our results suggest that multiple biological pathologies that can lead to different clinical expressions of LLD. This research was funded by: The Leo and Anne Albert Charitable Trust National Institute of Mental Health Grant R01 MH108578
Poster Number: EI - 31
EXERCISE AS AN AUGMENTATION TO PHARMACOTHERAPY FOR DEPRESSION IN OLDER AND YOUNGER ADULTS: A FEASIBILITY TRIAL EXPLORING BIOLOGICAL MECHANISMS
Swathi Gujral1,2; Howard Aizenstein2; Meryl Butters2; Charles F. Reynolds III2; George Grove2; Jordan Karp2; Kirk Erickson2 1
VA Pittsburgh Healthcare System Mental Illness Research and Education Clinical Center University of Pittsburgh
2
Introduction: Exercise interventions for depression that also examine biological mechanisms are rare and none have included both younger and older adults with Major Depression. Our pilot intervention study tested the feasibility of conducting a physical exercise intervention as augmentation to pharmacotherapy for depression in younger and older adults while also exploring possible neural mechanisms underlying the antidepressant effects of exercise. Methods: Fifteen sedentary younger (20-39 years) and older adults (60-79 years) meeting criteria for a Major Depressive Episode were randomized to receive a 12-week medication regimen of venlafaxine XR or venlafaxine XR plus physical exercise.
S140
Am J Geriatr Psychiatry 27:3S, March 2019
AAGP Annual Meeting 2019 The exercise intervention involved supervised moderate-intensity aerobic exercise sessions three times per week for 12 weeks. The primary aim was to develop the infrastructure for conducting an exercise intervention in adults with Major Depression while also collecting brain imaging measures to better understand mechanisms. The Montgomery Asberg Depression Rating Scale (MADRS) was used to assess change in depressive symptoms, the VO2submaximal test was used to assess change in cardiorespiratory fitness, and 7T structural MR imaging was used to assess change in regional brain morphology (i.e., cortical thickness) relevant to depression. Data analysis was conducted using repeated measures ANOVA and paired-samples and independent samples t-tests. Results: Our results demonstrated feasibility of conducting a physical exercise intervention combined with pharmacotherapy trial in depressed younger and older adults. Ten younger adults and five older adults were randomized to receive treatment and 11 participants completed the study. There was 0% attrition and a 91% attendance rate (i.e., 33/36 sessions) among participants engaged in the exercise intervention. Although efficacy of the intervention was unable to be tested, trends suggested that the addition of physical exercise to medication treatment for depression may lead to rapid and stable decline in depressive symptoms and exercise-related improvements in cardiorespiratory fitness may be linked to an increase in cortical thickness in regions sensitive to depression (i.e., orbitofrontal cortex, anterior cingulate cortex, parahippocampal gyrus). Further, sensitivity analyses suggested that treatment-related increases in cortical thickness in the right medial orbitofrontal cortex and right rostral anterior cingulate cortex were associated with improved performance on measures of verbal learning and memory (p< 0.05). Conclusions: This pilot clinical trial involving physical exercise as an augmentation to antidepressant medication treatment enabled this interdisciplinary research team to develop the infrastructure for conducting an exercise intervention for depression in late-life and early adulthood while also examining biological mechanisms. Recruitment challenges were overcome, and intervention adherence was exceptional. Trending associations between exercise-related improvements in fitness and changes in cortical thickness are promising avenues for future large-scale studies to explore. This research was funded by: This project was supported by the Advanced Center for Intervention and Services Research (ACISR). PDF: http://submissions.mirasmart.com/Verify/AAGP2019/Original/AAGP2019-000336/AAGP2019-000336_Fig1.pdf PDF: http://submissions.mirasmart.com/Verify/AAGP2019/Original/AAGP2019-000336/AAGP2019-000336_Fig2.pdf
Medication Only Variable Age Sex (% Female) Education Race (%White) MADRS Baseline Duration MDE (weeks) Baseline Age at st MDE % Antidepressant Use Baseline BMI Baseline Est. VO2 Max Baseline
Medication +Exercise
Older (N=3)
Younger (N=5)
Older (N=2)
Younger (N=5)
62.33 100 15.33 100 22.33 (3.51) 208.44 (269.91) 53.00 (8.89) 33 30.35 (1.70) 27.73 (8.13)
33.60 60 14.40 80 24.50 (5.20) 55.8 (47.0) 24.00 (4.63) 20 32.04 (3.61) 26.73 (3.47)
67.50 50 16.00 50 24.50 (0.71) 27.50 (34.64) 41.5 (16.26) 0 26.62 (4.19) 26.12 (6.78)
28.60 60 16.40 60 24.50 (6.46) 28.2(29.3) 17.20(8.34) 0 28.34 (7.40) 30.40(6.62)
Poster Number: EI - 32
EXPERIENCES OF END-OF-LIFE CARE BY NON-WESTERN PATIENTS: A THEMATIC ANALYSIS. Adam Herbstsomer; Sarah Stahl; Howard Aizenstein University of Pittsburgh Introduction: The use of end-of-life services, including palliative care and hospice, is increasing worldwide. However, ethnic minority groups utilize end-of-life services at a lower rate than majority groups despite having greater morbidity and mortality associated with both malignant and non-malignant terminal conditions. Additionally, the quality of patient experience has been demonstrated to be lower among ethnic minority groups. While the field of palliative care has recognized the importance of a cross-cultural approach, the specifics regarding how this could be implemented are ill-defined. One major barrier is that no one provider can be familiar with the many cultural groups that they may encounter in clinical practice. The purpose of this study is
Am J Geriatr Psychiatry 27:3S, March 2019
S141
Poster Number: EI - 30
ASSOCIATION BETWEEN WHITE MATTER HYPERINTENSITIES, FRONTAL BRAIN VOLUMES AND NEUROTICISM IN LATE LIFE DEPRESSION Chinaka Joseph; Lihong Wang; Kevin Manning; Rong Wu; David Steffens University of Connecticut School of Medicine Introduction: The neurobiology of neuroticism in late life depression (LLD) is understudied. Previous structural imaging research has linked both smaller hippocampal volumes and greater volume of vascular white matter changes to LLD. We hypothesized older depressed subjects scoring high in measures of neuroticism would have smaller hippocampal volumes compared with non-neurotic older depressed subjects and with non-depressed controls. Methods: Non-demented subjects were recruited and were either depressed with high neuroticism, depressed with low neuroticism or not depressed (control). Neuroticism was assessed using the NEO PI. A study psychiatrist confirmed or ruled out diagnosis of depression for depressed and control subjects. Brain MRIs were performed. Results: The study sample consisted of 128 older depressed subjects and 36 never depressed controls. Subjects had a mean age of 72 and were 70% female. 50% of depressed subjects scored high on the NEO-PI neuroticism measure. For outcomes focusing on white matter changes, we found that non-neurotic depressed subjects had a higher volume of white matter vascular change than did neurotic depressed subjects and non-depressed controls. For imaging outcomes focused on volumetric analyses, we several frontal lobe regions for which depressed subjects with high neuroticism scores had smaller volumes compared with non-neurotic older depressed subjects and with non-depressed controls, controlling for age and gender. These regions included frontal pole, medial orbitofrontal cortex and left pars orbitalis. We did not find significant between-group differences in hippocampal volume. Conclusions: In late-life depression hippocampal volume was not associated with depression or neuroticism. Our finding that those depressed subjects low in neuroticism had higher white matter vascular change volumes is consistent with prior literature on “vascular depression.” However, our finding that those high in neuroticism had similar white matter vascular change to controls implies that there may be a different neurobiological mechanism in older neurotic depressed group. This notion is supported by our finding that several frontal lobe structures were smaller in patients who scored high in measures of neuroticism than in non-neurodepressed subjects and in non-depressed controls. Our results suggest that multiple biological pathologies that can lead to different clinical expressions of LLD. This research was funded by: The Leo and Anne Albert Charitable Trust National Institute of Mental Health Grant R01 MH108578
Poster Number: EI - 31
EXERCISE AS AN AUGMENTATION TO PHARMACOTHERAPY FOR DEPRESSION IN OLDER AND YOUNGER ADULTS: A FEASIBILITY TRIAL EXPLORING BIOLOGICAL MECHANISMS
Swathi Gujral1,2; Howard Aizenstein2; Meryl Butters2; Charles F. Reynolds III2; George Grove2; Jordan Karp2; Kirk Erickson2 1
VA Pittsburgh Healthcare System Mental Illness Research and Education Clinical Center University of Pittsburgh
2
Introduction: Exercise interventions for depression that also examine biological mechanisms are rare and none have included both younger and older adults with Major Depression. Our pilot intervention study tested the feasibility of conducting a physical exercise intervention as augmentation to pharmacotherapy for depression in younger and older adults while also exploring possible neural mechanisms underlying the antidepressant effects of exercise. Methods: Fifteen sedentary younger (20-39 years) and older adults (60-79 years) meeting criteria for a Major Depressive Episode were randomized to receive a 12-week medication regimen of venlafaxine XR or venlafaxine XR plus physical exercise.
S140
Am J Geriatr Psychiatry 27:3S, March 2019
AAGP Annual Meeting 2019 The exercise intervention involved supervised moderate-intensity aerobic exercise sessions three times per week for 12 weeks. The primary aim was to develop the infrastructure for conducting an exercise intervention in adults with Major Depression while also collecting brain imaging measures to better understand mechanisms. The Montgomery Asberg Depression Rating Scale (MADRS) was used to assess change in depressive symptoms, the VO2submaximal test was used to assess change in cardiorespiratory fitness, and 7T structural MR imaging was used to assess change in regional brain morphology (i.e., cortical thickness) relevant to depression. Data analysis was conducted using repeated measures ANOVA and paired-samples and independent samples t-tests. Results: Our results demonstrated feasibility of conducting a physical exercise intervention combined with pharmacotherapy trial in depressed younger and older adults. Ten younger adults and five older adults were randomized to receive treatment and 11 participants completed the study. There was 0% attrition and a 91% attendance rate (i.e., 33/36 sessions) among participants engaged in the exercise intervention. Although efficacy of the intervention was unable to be tested, trends suggested that the addition of physical exercise to medication treatment for depression may lead to rapid and stable decline in depressive symptoms and exercise-related improvements in cardiorespiratory fitness may be linked to an increase in cortical thickness in regions sensitive to depression (i.e., orbitofrontal cortex, anterior cingulate cortex, parahippocampal gyrus). Further, sensitivity analyses suggested that treatment-related increases in cortical thickness in the right medial orbitofrontal cortex and right rostral anterior cingulate cortex were associated with improved performance on measures of verbal learning and memory (p< 0.05). Conclusions: This pilot clinical trial involving physical exercise as an augmentation to antidepressant medication treatment enabled this interdisciplinary research team to develop the infrastructure for conducting an exercise intervention for depression in late-life and early adulthood while also examining biological mechanisms. Recruitment challenges were overcome, and intervention adherence was exceptional. Trending associations between exercise-related improvements in fitness and changes in cortical thickness are promising avenues for future large-scale studies to explore. This research was funded by: This project was supported by the Advanced Center for Intervention and Services Research (ACISR). PDF: http://submissions.mirasmart.com/Verify/AAGP2019/Original/AAGP2019-000336/AAGP2019-000336_Fig1.pdf PDF: http://submissions.mirasmart.com/Verify/AAGP2019/Original/AAGP2019-000336/AAGP2019-000336_Fig2.pdf
Medication Only Variable Age Sex (% Female) Education Race (%White) MADRS Baseline Duration MDE (weeks) Baseline Age at st MDE % Antidepressant Use Baseline BMI Baseline Est. VO2 Max Baseline
Medication +Exercise
Older (N=3)
Younger (N=5)
Older (N=2)
Younger (N=5)
62.33 100 15.33 100 22.33 (3.51) 208.44 (269.91) 53.00 (8.89) 33 30.35 (1.70) 27.73 (8.13)
33.60 60 14.40 80 24.50 (5.20) 55.8 (47.0) 24.00 (4.63) 20 32.04 (3.61) 26.73 (3.47)
67.50 50 16.00 50 24.50 (0.71) 27.50 (34.64) 41.5 (16.26) 0 26.62 (4.19) 26.12 (6.78)
28.60 60 16.40 60 24.50 (6.46) 28.2(29.3) 17.20(8.34) 0 28.34 (7.40) 30.40(6.62)
Poster Number: EI - 32
EXPERIENCES OF END-OF-LIFE CARE BY NON-WESTERN PATIENTS: A THEMATIC ANALYSIS. Adam Herbstsomer; Sarah Stahl; Howard Aizenstein University of Pittsburgh Introduction: The use of end-of-life services, including palliative care and hospice, is increasing worldwide. However, ethnic minority groups utilize end-of-life services at a lower rate than majority groups despite having greater morbidity and mortality associated with both malignant and non-malignant terminal conditions. Additionally, the quality of patient experience has been demonstrated to be lower among ethnic minority groups. While the field of palliative care has recognized the importance of a cross-cultural approach, the specifics regarding how this could be implemented are ill-defined. One major barrier is that no one provider can be familiar with the many cultural groups that they may encounter in clinical practice. The purpose of this study is
Am J Geriatr Psychiatry 27:3S, March 2019
S141