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In This Issue Geriatric depression consists of complex and heterogeneous behaviors unlikely to be caused by a single brain lesion. How- ever, abnormalities in specific brain structures and their inter- connections may confer vulnerability to the development of late-life depression. Hoptman et al. (pg. 812) review structural magnetic resonance imaging methods that can be used to identify these abnormalities. They argue that the available methods provide complementary information that, when combined judiciously, can conceptually advance the field of geriatric depression. The degree to which the association between brain structure and cognition varies by age is not fully understood. The current study by Zimmerman et al. (pg. 823) sought to exam- ine this relationship using cognitive assessment and MRI- derived brain volumes in healthy adults across the lifespan. The findings suggested that healthy older individuals with lateral frontal lobe gray matter loss may be more susceptible to behavioral disruptions requiring an ability to organize and successfully execute goal-oriented activities. Depression is common in older people, and is associated with vascular disease. Using brain imaging techniques (MRI) in 626 older people in the EU LADIS study, O’Brien et al. (pg. 834) examined whether a specific type and/or location of brain vascular disease was associated with depression. They found that white matter disruption rather than small strokes was associated with depression, and that depression was more strongly linked to damage in some brain areas (frontal and temporal lobes) than others. Magnetic resonance imaging of elderly subjects frequently shows regions of white matter damage, called white matter hyperintensities (WMH). Burton et al. (pg. 842) measured changes in WMH volume over two years in people with different dementias and healthy people. Initially those with Alzheimer disease had more WMH than other groups. The increase in WMH volume was not different between groups, but was dependent upon the original WMH volume, with larger initial volumes associated with greater rates of progres- sion. In order to investigate the determinants of subjective well- being Schneider et al. (pg. 850) examined 56 60 year-old geriatric inpatients by means of psychometric scales and bio- graphic interviews. Despite a marked increase in physical disability over a period of five years, subjective well-being remained stable. Subjective well-being at the second measure- ment point was influenced much more by the individual’s subjective evaluation of the present situation and by the sense of coherence than by aging and functional impairment. Reid et al. (pg. 860), in their study, found sleep complaints, when elicited, predicted mental and physical health related quality of life status in elderly populations with comorbid illnesses. Excessive day-time sleepiness best predicted poor mental and physical health related quality of life. Yet, a sleep complaint was often not reported in the patients chart. Given the evidence of a relationship between sleep and health, iden- tification of sleep disorders could lead to improved manage- ment of common chronic illnesses and quality of life of elderly patients. This study by Ahmed et al. (pg. 867) tested the hypothesis that among community-dwelling older adults with a primary hos- pital discharge diagnosis of heart failure, presence of a sec- ondary diagnosis of depression was associated with admis- sion to nursing homes. Using National Hospital Discharge Survey data and employing propensity score technique, the authors demonstrate that hospitalized heart failure patients were more likely to be newly admitted to nursing homes at the time of discharge if they had a secondary diagnosis of depres- sion. In the first comprehensive study of psychiatric problems in assisted living, Watson et al. (pg. 876) found depression to be common, under-treated, and related to physical problems. Even when accounting for age and dementia, those requiring the most physical assistance were four times as likely to be depressed as physically independent residents. Few de- pressed residents had any source of psychiatric care. Assisted living is a rapidly growing segment of long-term care, and represents an important setting in which to find and treat serious depression. Late-life depression is a major public health issue. This study by Hinton et al. (pg. 884) examined gender differences in prior depression treatment among depressed older adults in pri- mary care. Clinicians were also interviewed to identify treat- ment barriers for men. Older men, compared with women, reported lower rates of depression treatment. Clinicians find care of depressed older men more difficult because their de- pression is expressed atypically, traditional masculinity inhib- its help-seeking, and depression stigma is amplified. Dementia usually comes on gradually, but in some people can appear to have come on suddenly. Whether it should really be called ‘dementia’ in such cases has been disputed. Although this is recognized for impaired cognition after a stroke, there are other situations in which chronic types of cognitive im- pairment appears to manifest suddenly. King et al. (pg. 893) documented how often this happens, and that it generally has a worse prognosis than cognitive impairment that comes on gradually.

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Geriatric depression consists of complex and heterogeneousbehaviors unlikely to be caused by a single brain lesion. How-ever, abnormalities in specific brain structures and their inter-connections may confer vulnerability to the development oflate-life depression. Hoptman et al. (pg. 812) review structuralmagnetic resonance imaging methods that can be used toidentify these abnormalities. They argue that the availablemethods provide complementary information that, whencombined judiciously, can conceptually advance the field ofgeriatric depression.

The degree to which the association between brain structureand cognition varies by age is not fully understood. Thecurrent study by Zimmerman et al. (pg. 823) sought to exam-ine this relationship using cognitive assessment and MRI-derived brain volumes in healthy adults across the lifespan.The findings suggested that healthy older individuals withlateral frontal lobe gray matter loss may be more susceptible tobehavioral disruptions requiring an ability to organize andsuccessfully execute goal-oriented activities.

Depression is common in older people, and is associated withvascular disease. Using brain imaging techniques (MRI) in 626older people in the EU LADIS study, O’Brien et al. (pg. 834)examined whether a specific type and/or location of brainvascular disease was associated with depression. They foundthat white matter disruption rather than small strokes wasassociated with depression, and that depression was morestrongly linked to damage in some brain areas (frontal andtemporal lobes) than others.

Magnetic resonance imaging of elderly subjects frequentlyshows regions of white matter damage, called white matterhyperintensities (WMH). Burton et al. (pg. 842) measuredchanges in WMH volume over two years in people withdifferent dementias and healthy people. Initially those withAlzheimer disease had more WMH than other groups. Theincrease in WMH volume was not different between groups,but was dependent upon the original WMH volume, withlarger initial volumes associated with greater rates of progres-sion.

In order to investigate the determinants of subjective well-being Schneider et al. (pg. 850) examined 56 �60 year-oldgeriatric inpatients by means of psychometric scales and bio-graphic interviews. Despite a marked increase in physicaldisability over a period of five years, subjective well-beingremained stable. Subjective well-being at the second measure-ment point was influenced much more by the individual’ssubjective evaluation of the present situation and by the senseof coherence than by aging and functional impairment.

Reid et al. (pg. 860), in their study, found sleep complaints,when elicited, predicted mental and physical health relatedquality of life status in elderly populations with comorbidillnesses. Excessive day-time sleepiness best predicted poormental and physical health related quality of life. Yet, a sleepcomplaint was often not reported in the patients chart. Giventhe evidence of a relationship between sleep and health, iden-tification of sleep disorders could lead to improved manage-ment of common chronic illnesses and quality of life of elderlypatients.

This study by Ahmed et al. (pg. 867) tested the hypothesis thatamong community-dwelling older adults with a primary hos-pital discharge diagnosis of heart failure, presence of a sec-ondary diagnosis of depression was associated with admis-sion to nursing homes. Using National Hospital DischargeSurvey data and employing propensity score technique, theauthors demonstrate that hospitalized heart failure patientswere more likely to be newly admitted to nursing homes at thetime of discharge if they had a secondary diagnosis of depres-sion.

In the first comprehensive study of psychiatric problems inassisted living, Watson et al. (pg. 876) found depression to becommon, under-treated, and related to physical problems.Even when accounting for age and dementia, those requiringthe most physical assistance were four times as likely to bedepressed as physically independent residents. Few de-pressed residents had any source of psychiatric care. Assistedliving is a rapidly growing segment of long-term care, andrepresents an important setting in which to find and treatserious depression.

Late-life depression is a major public health issue. This studyby Hinton et al. (pg. 884) examined gender differences in priordepression treatment among depressed older adults in pri-mary care. Clinicians were also interviewed to identify treat-ment barriers for men. Older men, compared with women,reported lower rates of depression treatment. Clinicians findcare of depressed older men more difficult because their de-pression is expressed atypically, traditional masculinity inhib-its help-seeking, and depression stigma is amplified.

Dementia usually comes on gradually, but in some people canappear to have come on suddenly. Whether it should really becalled ‘dementia’ in such cases has been disputed. Althoughthis is recognized for impaired cognition after a stroke, thereare other situations in which chronic types of cognitive im-pairment appears to manifest suddenly. King et al. (pg. 893)documented how often this happens, and that it generally hasa worse prognosis than cognitive impairment that comes ongradually.