Journal Digest
Cognitive Decline in the Stroke Belt
Regional disparities in cognitive decline mirror regional disparities in stroke mortality, suggesting shared risk factors for these adverse outcomes.
This finding comes from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, an epidemiological study following a national cohort of adults aged 45 or older, recruited from 2003 to 2007. The group was 38 percent African American, with the other 62 percent of European descent; 56 percent were female. Another 56 percent were residents of the Stroke Belt, that region of the southeastern United States first described in 1965 as having 50 percent higher stroke mortality rates than the rest of the country.
Participants' global cognitive status was assessed annually by telephone with the Six-Item Screener (SIS) and every two years with fluency and recall tasks. A total of 23,913 participants who reported no stroke history and who were cognitively intact at enrollment (SIS score greater than 4) were included. Regional differences in incident cognitive impairment (SIS score less than or equal to 4) were adjusted for age, sex, race, education, and time between first and last assessments.
Of the participants, 1,937 declined to an SIS score less than or equal to 4 at the most recent assessment, over a mean of 4.1 (+/1.6) years. Stroke Belt residents had greater adjusted odds of incident cognitive impairment than residents of other states.
The study may point to a need to focus preventive health efforts on this geographical region: "Efforts to promote cerebrovascular and cognitive health should be directed to the Stroke Belt," said the study's authors.
Wadley V, Unverzagt F, McGuire L, et al. "Incident Cognitive Impairment Is Elevated in the Stroke Belt: The REGARDS Study." Ann Neurol, 2011. Mar 28 [Epub ahead of print]. An abstract is posted at <www.ncbi.nlm.nih.gov/pubmed/21618586>.
ADHD May Predict Development of Substance Use Disorders
Researchers at the Clinical and Research Program in Pediatric Psychopharmacology at Massachusetts General Hospital have determined that attention-deficit/hyperactivity disorder (ADHD) is a significant risk factor for development of substance use disorders and cigarette smoking in both sexes.
The group followed two cohorts of children and adolescents, one with 268 subjects with DSM-III-R diagnosed ADHD and one with 229 subjects without ADHD, prospectively and blindly over 10 years into young adulthood. They sought to identify clinically meaningful characteristics of children that predicted the development of substance use disorders and to see whether the role of these characteristics varied by gender.
ADHD was found to be a significant predictor of any substance use disorder and of cigarette smoking. In subjects with ADHD, comorbid conduct disorder and oppositional defiant disorder at baseline were also found to be significant predictors of substance use disorders. Similar results were found for cigarette-, alcohol-, and drug-use disorders. No clinically significant associations were found for any social or family environment factors or for cognitive functioning factors.
Wilens T, Martelon M, Joshi G, et al. "Does ADHD Predict Substance-Use Disorders? A 10-Year Follow-up Study of Young Adults With ADHD." J Am Acad Child Adolesc Psychiatry, 2011. 50(6): 543-553. An abstract is posted at <www.ncbi.nlm.nih.gov/pubmed/21621138>.
Antidepressants Reduce Risk of Suicidal Behavior in 27-Year Study
A study evaluating the association of antidepressants with suicide attempts and suicide deaths found that although those with more severe affective syndromes were more likely to initiate treatment, antidepressants were associated with a significant reduction in the risk of suicidal behavior.
This longitudinal, observational study of mood disorders with prospective assessments for up to 27 years was conducted at five U.S. academic medical centers. The study sample included 757 participants who enrolled from 1979 to 1981 during an episode of mania, depression, or schizoaffective disorder, each of those episodes assessed via Research Diagnostic Criteria. The analyses included participants with psychiatric and other medical comorbidity and those receiving acute or maintenance therapy, polypharmacy, or no psychopharmacologic treatment. Propensity score-adjusted mixed-effects survival analyses were used to examine risk of suicide attempt or suicide, the primary outcome.
The study's authors also warn that despite the findings, "we believe that clinicians must closely monitor patients when an antidepressant is initiated."
Leon A, Solomon D, Li C, et al. "Antidepressants and Risks of Suicide and Suicide Attempts: A 27-Year Observational Study." J Clin Psychiatry, 2011. 72(5): 580-586. An abstract is posted at <www.ncbi.nlm.nih.gov/pubmed/21658345>.
Sleep Disorders in Elderly May Have Childhood Origins
Researchers at the University of Southern California's Davis School of Gerontology have found a significant association between childhood parental emotional abuse and poorer sleep quality among older adults.
Multiple regression analyses were performed on data from 877 adults aged 60 or older from the National Survey of Midlife Development in the United States. Adverse childhood experiences were retrospectively recalled in one period (1995-1996). Sleep complaints, relationship strain, and emotional distress were assessed at another period (2004-2006).
Early parental emotional abuse was significantly associated with more sleep complaints in old age. Unsupportive interactions with family, friends, and significant others, and emotional distress partially explained the association.
"Parental emotional abuse in childhood hindered the development of supportive social relationships later in life, which was associated with more emotional distress, and exerted a negative influence on subjective sleep quality among older adults," said the authors.
Poon C, Knight B. "Impact of Childhood Parental Abuse and Neglect on Sleep Problems in Old Age." J Gerontol B Psychol Sci Soc Sci, 2011. 66(3): 307-310. An abstract is posted at <www.ncbi.nlm.nih.gov/pubmed/21339302>.
Antidepressants' Impact on Life Quality in Neurological Patients Uncertain
A meta-analysis of 20 randomized controlled trials including patients with Parkinson's disease, multiple sclerosis, brain injury, epilepsy, and stroke has found that antidepressants are effective for the treatment of depression in these patients, but evidence for the efficacy of antidepressants in improving quality of life and functional and cognitive outcomes in neurological disorders is inconclusive.
Researchers at King's College London's Department of Psychological Medicine and Department of Palliative Care, Policy, and Rehabilitation performed the review, hoping to provide evidence as to whether antidepressants could be more broadly recommended for patients with depression in the context of a neurological disorder, and also whether the evidence in this population differs from the evidence for antidepressant use in other physically ill populations. "On the basis of this review, it is possible to recommend treatment with antidepressants for patients with neurological disorders, but there are limitations as to whether this applies to all neurological diseases, due to the relatively small number of disorders described in the studies reviewed," said the authors, who also said the findings of their study reiterated the need for more randomized, controlled trials of antidepressant treatment for this population.
Price A, Rayner L, Okon-Rocha E, et al. "Antidepressants for the Treatment of Depression in Neurological Disorders: A Systematic Review and Meta-Analysis of Randomised Controlled Trials." J Neurol Neurosurg Psychiatry, 2011. An abstract is posted at <www.ncbi.nlm.nih.gov/pubmed/21558287>.
Mechanism of Antidepressant Response to Ketamine Sought
University of Texas Southwestern Medical Center scientists have attempted to shed light on the mechanism by which ketamine produces a fast-acting antidepressant response in patients with treatment-resistant depression. Clinical studies have consistently demonstrated that a single sub-psychomimetic dose of ketamine, an ionotropic glutamatergic N-methyl-D-aspartate (NMDA) antagonist, consistently produces antidepressant effects within hours of administration. Studies of the acute effects of ketamine in mice point to NMDA receptor blockade as a possible mechanism for the antidepressant response. "We hope our investigation provides critical information to treat depression effectively sooner," said lead investigator Lisa Monteggia, M.D.
Autry A, Adachi M, Nosreva E, et al. "NMDA Receptor Blockade at Rest Triggers Rapid Behavioural Antidepressant Responses." Nature, 2011. Jun 15 [Epub ahead of print]. An abstract is posted at <www.ncbi.nlm.nih.gov/pubmed/21677641>.
