American Association for Geriatric Psychiatry (AAGP)

SAN ANTONIO – Older adults with diabetes who frequently have hypoglycemia may be especially vulnerable to the development of cognitive impairment or dementia, suggest data from a study of nearly half a million veterans.

The findings also suggest that patients aged 65 years and older with diabetes should have cognitive screening, and that there should be increased overall surveillance in this population, according to Dr. Denise G. Feil, a geriatric psychiatrist at the VA Greater Los Angeles Healthcare System, and colleagues.

An examination of the association of antidiabetic treatment with rates of ICD-9-CM–coded hypoglycemia in 497,900 veterans aged 65 years and older with diabetes showed that veterans who had cognitive impairment (CI) or dementia had significantly higher rates of hypoglycemia than did their cognitively intact peers in both adjusted and unadjusted analyses, the researchers reported.

"The risk of hypoglycemia is higher even when their medication regimen is the same and their [hemoglobin A_1c] levels are the same as those of patients without dementia, which suggest that there are social factors that might be different in this patient population. There may be other issues that are neurological, such as whether neuroglycopenia from repeat hypoglycemia is having some kind of effect," said Dr. Feil in an interview at the annual meeting of the American Association for Geriatric Psychiatry.

Dietary changes that occur as cognitive impairment progresses into dementia may also make cognitively impaired diabetics more susceptible to hypoglycemia, and memory problems may make compliance difficult, especially when patients have complicated or intensive antidiabetic regimens, she added.

Diabetes is associated with a doubling of the risk of cognitive impairment and dementia, and intensive glycemic control has been shown to significantly decrease the risk of diabetes-associated complications. But the risk/benefit trade-off of intensive glycemic control in cognitively impaired patients has not been studied, the authors stated.

"Recent trials of intensive glycemic control in older patients with diabetes of longer duration showed a lack of benefit and higher rates of hypoglycemia, macrovascular events, and death," they wrote.

They hypothesized that they would find that diabetics with dementia or CI would be managed less aggressively than would cognitively normal diabetics of the same age, but would still have similar rates of hypoglycemia after adjustments.

The investigators tested this idea by conducting a cross-sectional analysis of data on veterans who were treated at Department of Veterans Affairs facilities in fiscal years 2002 and 2003, stratified by coded dementia and cognitive impairment, age, antiglycemic medications, and HbA_1c values.

They found that 18% of the population had a diagnosis of either dementia or cognitive impairment, and that the proportion and distribution of antidiabetic prescriptions were similar among patients with dementia, CI, or neither condition.

They also found that hypoglycemia rates rose with both increasing cognitive impairment and the complexity of the diabetes regimen, yet the mean HbA_1c levels were nearly identical among all three cognitive groups: 7.0% for those with dementia, 6.9% for patients with CI, and 7.0% for those with neither dementia nor CI.

But when the authors looked at the unadjusted odds of hypoglycemia, they found that patients with dementia were more than twice as likely as cognitively normal patients to have hypoglycemia (odds ratio, 2.4), and those with cognitive impairment were likely to have a nearly twofold greater risk of hypoglycemia (OR, 1.7).

Adjustment for potential confounders slightly lowered – but did not eliminate – the excess hypoglycemia in patients with dementia and cognitive impairment (OR, 1.8 and 1.2, respectively).

The study was funded by the VA’s Health Services Research and Development Service. Dr. Feil received a VA Career Development Award.

SAN ANTONIO – Older adults with diabetes who frequently have hypoglycemia may be especially vulnerable to the development of cognitive impairment or dementia, suggest data from a study of nearly half a million veterans.

The findings also suggest that patients aged 65 years and older with diabetes should have cognitive screening, and that there should be increased overall surveillance in this population, according to Dr. Denise G. Feil, a geriatric psychiatrist at the VA Greater Los Angeles Healthcare System, and colleagues.

An examination of the association of antidiabetic treatment with rates of ICD-9-CM–coded hypoglycemia in 497,900 veterans aged 65 years and older with diabetes showed that veterans who had cognitive impairment (CI) or dementia had significantly higher rates of hypoglycemia than did their cognitively intact peers in both adjusted and unadjusted analyses, the researchers reported.

"The risk of hypoglycemia is higher even when their medication regimen is the same and their [hemoglobin A_1c] levels are the same as those of patients without dementia, which suggest that there are social factors that might be different in this patient population. There may be other issues that are neurological, such as whether neuroglycopenia from repeat hypoglycemia is having some kind of effect," said Dr. Feil in an interview at the annual meeting of the American Association for Geriatric Psychiatry.

Dietary changes that occur as cognitive impairment progresses into dementia may also make cognitively impaired diabetics more susceptible to hypoglycemia, and memory problems may make compliance difficult, especially when patients have complicated or intensive antidiabetic regimens, she added.

Diabetes is associated with a doubling of the risk of cognitive impairment and dementia, and intensive glycemic control has been shown to significantly decrease the risk of diabetes-associated complications. But the risk/benefit trade-off of intensive glycemic control in cognitively impaired patients has not been studied, the authors stated.

"Recent trials of intensive glycemic control in older patients with diabetes of longer duration showed a lack of benefit and higher rates of hypoglycemia, macrovascular events, and death," they wrote.

They hypothesized that they would find that diabetics with dementia or CI would be managed less aggressively than would cognitively normal diabetics of the same age, but would still have similar rates of hypoglycemia after adjustments.

The investigators tested this idea by conducting a cross-sectional analysis of data on veterans who were treated at Department of Veterans Affairs facilities in fiscal years 2002 and 2003, stratified by coded dementia and cognitive impairment, age, antiglycemic medications, and HbA_1c values.

They found that 18% of the population had a diagnosis of either dementia or cognitive impairment, and that the proportion and distribution of antidiabetic prescriptions were similar among patients with dementia, CI, or neither condition.

They also found that hypoglycemia rates rose with both increasing cognitive impairment and the complexity of the diabetes regimen, yet the mean HbA_1c levels were nearly identical among all three cognitive groups: 7.0% for those with dementia, 6.9% for patients with CI, and 7.0% for those with neither dementia nor CI.

But when the authors looked at the unadjusted odds of hypoglycemia, they found that patients with dementia were more than twice as likely as cognitively normal patients to have hypoglycemia (odds ratio, 2.4), and those with cognitive impairment were likely to have a nearly twofold greater risk of hypoglycemia (OR, 1.7).

Adjustment for potential confounders slightly lowered – but did not eliminate – the excess hypoglycemia in patients with dementia and cognitive impairment (OR, 1.8 and 1.2, respectively).

The study was funded by the VA’s Health Services Research and Development Service. Dr. Feil received a VA Career Development Award.

SAN ANTONIO – Older adults with diabetes who frequently have hypoglycemia may be especially vulnerable to the development of cognitive impairment or dementia, suggest data from a study of nearly half a million veterans.

The findings also suggest that patients aged 65 years and older with diabetes should have cognitive screening, and that there should be increased overall surveillance in this population, according to Dr. Denise G. Feil, a geriatric psychiatrist at the VA Greater Los Angeles Healthcare System, and colleagues.

An examination of the association of antidiabetic treatment with rates of ICD-9-CM–coded hypoglycemia in 497,900 veterans aged 65 years and older with diabetes showed that veterans who had cognitive impairment (CI) or dementia had significantly higher rates of hypoglycemia than did their cognitively intact peers in both adjusted and unadjusted analyses, the researchers reported.

"The risk of hypoglycemia is higher even when their medication regimen is the same and their [hemoglobin A_1c] levels are the same as those of patients without dementia, which suggest that there are social factors that might be different in this patient population. There may be other issues that are neurological, such as whether neuroglycopenia from repeat hypoglycemia is having some kind of effect," said Dr. Feil in an interview at the annual meeting of the American Association for Geriatric Psychiatry.

Dietary changes that occur as cognitive impairment progresses into dementia may also make cognitively impaired diabetics more susceptible to hypoglycemia, and memory problems may make compliance difficult, especially when patients have complicated or intensive antidiabetic regimens, she added.

Diabetes is associated with a doubling of the risk of cognitive impairment and dementia, and intensive glycemic control has been shown to significantly decrease the risk of diabetes-associated complications. But the risk/benefit trade-off of intensive glycemic control in cognitively impaired patients has not been studied, the authors stated.

"Recent trials of intensive glycemic control in older patients with diabetes of longer duration showed a lack of benefit and higher rates of hypoglycemia, macrovascular events, and death," they wrote.

They hypothesized that they would find that diabetics with dementia or CI would be managed less aggressively than would cognitively normal diabetics of the same age, but would still have similar rates of hypoglycemia after adjustments.

The investigators tested this idea by conducting a cross-sectional analysis of data on veterans who were treated at Department of Veterans Affairs facilities in fiscal years 2002 and 2003, stratified by coded dementia and cognitive impairment, age, antiglycemic medications, and HbA_1c values.

They found that 18% of the population had a diagnosis of either dementia or cognitive impairment, and that the proportion and distribution of antidiabetic prescriptions were similar among patients with dementia, CI, or neither condition.

They also found that hypoglycemia rates rose with both increasing cognitive impairment and the complexity of the diabetes regimen, yet the mean HbA_1c levels were nearly identical among all three cognitive groups: 7.0% for those with dementia, 6.9% for patients with CI, and 7.0% for those with neither dementia nor CI.

But when the authors looked at the unadjusted odds of hypoglycemia, they found that patients with dementia were more than twice as likely as cognitively normal patients to have hypoglycemia (odds ratio, 2.4), and those with cognitive impairment were likely to have a nearly twofold greater risk of hypoglycemia (OR, 1.7).

Adjustment for potential confounders slightly lowered – but did not eliminate – the excess hypoglycemia in patients with dementia and cognitive impairment (OR, 1.8 and 1.2, respectively).

The study was funded by the VA’s Health Services Research and Development Service. Dr. Feil received a VA Career Development Award.

SAN ANTONIO – Older adults with diabetes who frequently have hypoglycemia may be especially vulnerable to the development of cognitive impairment or dementia, suggest data from a study of nearly half a million veterans.

The findings also suggest that patients aged 65 years and older with diabetes should have cognitive screening, and that there should be increased overall surveillance in this population, according to Dr. Denise G. Feil, a geriatric psychiatrist at the VA Greater Los Angeles Healthcare System, and colleagues.

An examination of the association of antidiabetic treatment with rates of ICD-9-CM–coded hypoglycemia in 497,900 veterans aged 65 years and older with diabetes showed that veterans who had cognitive impairment (CI) or dementia had significantly higher rates of hypoglycemia than did their cognitively intact peers in both adjusted and unadjusted analyses, the researchers reported.

"The risk of hypoglycemia is higher even when their medication regimen is the same and their [hemoglobin A_1c] levels are the same as those of patients without dementia, which suggest that there are social factors that might be different in this patient population. There may be other issues that are neurological, such as whether neuroglycopenia from repeat hypoglycemia is having some kind of effect," said Dr. Feil in an interview at the annual meeting of the American Association for Geriatric Psychiatry.

Dietary changes that occur as cognitive impairment progresses into dementia may also make cognitively impaired diabetics more susceptible to hypoglycemia, and memory problems may make compliance difficult, especially when patients have complicated or intensive antidiabetic regimens, she added.

Diabetes is associated with a doubling of the risk of cognitive impairment and dementia, and intensive glycemic control has been shown to significantly decrease the risk of diabetes-associated complications. But the risk/benefit trade-off of intensive glycemic control in cognitively impaired patients has not been studied, the authors stated.

"Recent trials of intensive glycemic control in older patients with diabetes of longer duration showed a lack of benefit and higher rates of hypoglycemia, macrovascular events, and death," they wrote.

They hypothesized that they would find that diabetics with dementia or CI would be managed less aggressively than would cognitively normal diabetics of the same age, but would still have similar rates of hypoglycemia after adjustments.

The investigators tested this idea by conducting a cross-sectional analysis of data on veterans who were treated at Department of Veterans Affairs facilities in fiscal years 2002 and 2003, stratified by coded dementia and cognitive impairment, age, antiglycemic medications, and HbA_1c values.

They found that 18% of the population had a diagnosis of either dementia or cognitive impairment, and that the proportion and distribution of antidiabetic prescriptions were similar among patients with dementia, CI, or neither condition.

They also found that hypoglycemia rates rose with both increasing cognitive impairment and the complexity of the diabetes regimen, yet the mean HbA_1c levels were nearly identical among all three cognitive groups: 7.0% for those with dementia, 6.9% for patients with CI, and 7.0% for those with neither dementia nor CI.

But when the authors looked at the unadjusted odds of hypoglycemia, they found that patients with dementia were more than twice as likely as cognitively normal patients to have hypoglycemia (odds ratio, 2.4), and those with cognitive impairment were likely to have a nearly twofold greater risk of hypoglycemia (OR, 1.7).

Adjustment for potential confounders slightly lowered – but did not eliminate – the excess hypoglycemia in patients with dementia and cognitive impairment (OR, 1.8 and 1.2, respectively).

The study was funded by the VA’s Health Services Research and Development Service. Dr. Feil received a VA Career Development Award.

SAN ANTONIO – Older adults with diabetes who frequently have hypoglycemia may be especially vulnerable to the development of cognitive impairment or dementia, suggest data from a study of nearly half a million veterans.

The findings also suggest that patients aged 65 years and older with diabetes should have cognitive screening, and that there should be increased overall surveillance in this population, according to Dr. Denise G. Feil, a geriatric psychiatrist at the VA Greater Los Angeles Healthcare System, and colleagues.

An examination of the association of antidiabetic treatment with rates of ICD-9-CM–coded hypoglycemia in 497,900 veterans aged 65 years and older with diabetes showed that veterans who had cognitive impairment (CI) or dementia had significantly higher rates of hypoglycemia than did their cognitively intact peers in both adjusted and unadjusted analyses, the researchers reported.

"The risk of hypoglycemia is higher even when their medication regimen is the same and their [hemoglobin A_1c] levels are the same as those of patients without dementia, which suggest that there are social factors that might be different in this patient population. There may be other issues that are neurological, such as whether neuroglycopenia from repeat hypoglycemia is having some kind of effect," said Dr. Feil in an interview at the annual meeting of the American Association for Geriatric Psychiatry.

Dietary changes that occur as cognitive impairment progresses into dementia may also make cognitively impaired diabetics more susceptible to hypoglycemia, and memory problems may make compliance difficult, especially when patients have complicated or intensive antidiabetic regimens, she added.

Diabetes is associated with a doubling of the risk of cognitive impairment and dementia, and intensive glycemic control has been shown to significantly decrease the risk of diabetes-associated complications. But the risk/benefit trade-off of intensive glycemic control in cognitively impaired patients has not been studied, the authors stated.

"Recent trials of intensive glycemic control in older patients with diabetes of longer duration showed a lack of benefit and higher rates of hypoglycemia, macrovascular events, and death," they wrote.

They hypothesized that they would find that diabetics with dementia or CI would be managed less aggressively than would cognitively normal diabetics of the same age, but would still have similar rates of hypoglycemia after adjustments.

The investigators tested this idea by conducting a cross-sectional analysis of data on veterans who were treated at Department of Veterans Affairs facilities in fiscal years 2002 and 2003, stratified by coded dementia and cognitive impairment, age, antiglycemic medications, and HbA_1c values.

They found that 18% of the population had a diagnosis of either dementia or cognitive impairment, and that the proportion and distribution of antidiabetic prescriptions were similar among patients with dementia, CI, or neither condition.

They also found that hypoglycemia rates rose with both increasing cognitive impairment and the complexity of the diabetes regimen, yet the mean HbA_1c levels were nearly identical among all three cognitive groups: 7.0% for those with dementia, 6.9% for patients with CI, and 7.0% for those with neither dementia nor CI.

But when the authors looked at the unadjusted odds of hypoglycemia, they found that patients with dementia were more than twice as likely as cognitively normal patients to have hypoglycemia (odds ratio, 2.4), and those with cognitive impairment were likely to have a nearly twofold greater risk of hypoglycemia (OR, 1.7).

Adjustment for potential confounders slightly lowered – but did not eliminate – the excess hypoglycemia in patients with dementia and cognitive impairment (OR, 1.8 and 1.2, respectively).

The study was funded by the VA’s Health Services Research and Development Service. Dr. Feil received a VA Career Development Award.

SAN ANTONIO – Older adults with diabetes who frequently have hypoglycemia may be especially vulnerable to the development of cognitive impairment or dementia, suggest data from a study of nearly half a million veterans.

The findings also suggest that patients aged 65 years and older with diabetes should have cognitive screening, and that there should be increased overall surveillance in this population, according to Dr. Denise G. Feil, a geriatric psychiatrist at the VA Greater Los Angeles Healthcare System, and colleagues.

An examination of the association of antidiabetic treatment with rates of ICD-9-CM–coded hypoglycemia in 497,900 veterans aged 65 years and older with diabetes showed that veterans who had cognitive impairment (CI) or dementia had significantly higher rates of hypoglycemia than did their cognitively intact peers in both adjusted and unadjusted analyses, the researchers reported.

"The risk of hypoglycemia is higher even when their medication regimen is the same and their [hemoglobin A_1c] levels are the same as those of patients without dementia, which suggest that there are social factors that might be different in this patient population. There may be other issues that are neurological, such as whether neuroglycopenia from repeat hypoglycemia is having some kind of effect," said Dr. Feil in an interview at the annual meeting of the American Association for Geriatric Psychiatry.

Dietary changes that occur as cognitive impairment progresses into dementia may also make cognitively impaired diabetics more susceptible to hypoglycemia, and memory problems may make compliance difficult, especially when patients have complicated or intensive antidiabetic regimens, she added.

Diabetes is associated with a doubling of the risk of cognitive impairment and dementia, and intensive glycemic control has been shown to significantly decrease the risk of diabetes-associated complications. But the risk/benefit trade-off of intensive glycemic control in cognitively impaired patients has not been studied, the authors stated.

"Recent trials of intensive glycemic control in older patients with diabetes of longer duration showed a lack of benefit and higher rates of hypoglycemia, macrovascular events, and death," they wrote.

They hypothesized that they would find that diabetics with dementia or CI would be managed less aggressively than would cognitively normal diabetics of the same age, but would still have similar rates of hypoglycemia after adjustments.

The investigators tested this idea by conducting a cross-sectional analysis of data on veterans who were treated at Department of Veterans Affairs facilities in fiscal years 2002 and 2003, stratified by coded dementia and cognitive impairment, age, antiglycemic medications, and HbA_1c values.

They found that 18% of the population had a diagnosis of either dementia or cognitive impairment, and that the proportion and distribution of antidiabetic prescriptions were similar among patients with dementia, CI, or neither condition.

They also found that hypoglycemia rates rose with both increasing cognitive impairment and the complexity of the diabetes regimen, yet the mean HbA_1c levels were nearly identical among all three cognitive groups: 7.0% for those with dementia, 6.9% for patients with CI, and 7.0% for those with neither dementia nor CI.

But when the authors looked at the unadjusted odds of hypoglycemia, they found that patients with dementia were more than twice as likely as cognitively normal patients to have hypoglycemia (odds ratio, 2.4), and those with cognitive impairment were likely to have a nearly twofold greater risk of hypoglycemia (OR, 1.7).

Adjustment for potential confounders slightly lowered – but did not eliminate – the excess hypoglycemia in patients with dementia and cognitive impairment (OR, 1.8 and 1.2, respectively).

The study was funded by the VA’s Health Services Research and Development Service. Dr. Feil received a VA Career Development Award.

SAN ANTONIO – Older adults with diabetes who frequently have hypoglycemia may be especially vulnerable to the development of cognitive impairment or dementia, suggest data from a study of nearly half a million veterans.

The findings also suggest that patients aged 65 years and older with diabetes should have cognitive screening, and that there should be increased overall surveillance in this population, according to Dr. Denise G. Feil, a geriatric psychiatrist at the VA Greater Los Angeles Healthcare System, and colleagues.

An examination of the association of antidiabetic treatment with rates of ICD-9-CM–coded hypoglycemia in 497,900 veterans aged 65 years and older with diabetes showed that veterans who had cognitive impairment (CI) or dementia had significantly higher rates of hypoglycemia than did their cognitively intact peers in both adjusted and unadjusted analyses, the researchers reported.

"The risk of hypoglycemia is higher even when their medication regimen is the same and their [hemoglobin A_1c] levels are the same as those of patients without dementia, which suggest that there are social factors that might be different in this patient population. There may be other issues that are neurological, such as whether neuroglycopenia from repeat hypoglycemia is having some kind of effect," said Dr. Feil in an interview at the annual meeting of the American Association for Geriatric Psychiatry.

Dietary changes that occur as cognitive impairment progresses into dementia may also make cognitively impaired diabetics more susceptible to hypoglycemia, and memory problems may make compliance difficult, especially when patients have complicated or intensive antidiabetic regimens, she added.

Diabetes is associated with a doubling of the risk of cognitive impairment and dementia, and intensive glycemic control has been shown to significantly decrease the risk of diabetes-associated complications. But the risk/benefit trade-off of intensive glycemic control in cognitively impaired patients has not been studied, the authors stated.

"Recent trials of intensive glycemic control in older patients with diabetes of longer duration showed a lack of benefit and higher rates of hypoglycemia, macrovascular events, and death," they wrote.

They hypothesized that they would find that diabetics with dementia or CI would be managed less aggressively than would cognitively normal diabetics of the same age, but would still have similar rates of hypoglycemia after adjustments.

The investigators tested this idea by conducting a cross-sectional analysis of data on veterans who were treated at Department of Veterans Affairs facilities in fiscal years 2002 and 2003, stratified by coded dementia and cognitive impairment, age, antiglycemic medications, and HbA_1c values.

They found that 18% of the population had a diagnosis of either dementia or cognitive impairment, and that the proportion and distribution of antidiabetic prescriptions were similar among patients with dementia, CI, or neither condition.

They also found that hypoglycemia rates rose with both increasing cognitive impairment and the complexity of the diabetes regimen, yet the mean HbA_1c levels were nearly identical among all three cognitive groups: 7.0% for those with dementia, 6.9% for patients with CI, and 7.0% for those with neither dementia nor CI.

But when the authors looked at the unadjusted odds of hypoglycemia, they found that patients with dementia were more than twice as likely as cognitively normal patients to have hypoglycemia (odds ratio, 2.4), and those with cognitive impairment were likely to have a nearly twofold greater risk of hypoglycemia (OR, 1.7).

Adjustment for potential confounders slightly lowered – but did not eliminate – the excess hypoglycemia in patients with dementia and cognitive impairment (OR, 1.8 and 1.2, respectively).

The study was funded by the VA’s Health Services Research and Development Service. Dr. Feil received a VA Career Development Award.

SAN ANTONIO – Older adults with diabetes who frequently have hypoglycemia may be especially vulnerable to the development of cognitive impairment or dementia, suggest data from a study of nearly half a million veterans.

The findings also suggest that patients aged 65 years and older with diabetes should have cognitive screening, and that there should be increased overall surveillance in this population, according to Dr. Denise G. Feil, a geriatric psychiatrist at the VA Greater Los Angeles Healthcare System, and colleagues.

An examination of the association of antidiabetic treatment with rates of ICD-9-CM–coded hypoglycemia in 497,900 veterans aged 65 years and older with diabetes showed that veterans who had cognitive impairment (CI) or dementia had significantly higher rates of hypoglycemia than did their cognitively intact peers in both adjusted and unadjusted analyses, the researchers reported.

"The risk of hypoglycemia is higher even when their medication regimen is the same and their [hemoglobin A_1c] levels are the same as those of patients without dementia, which suggest that there are social factors that might be different in this patient population. There may be other issues that are neurological, such as whether neuroglycopenia from repeat hypoglycemia is having some kind of effect," said Dr. Feil in an interview at the annual meeting of the American Association for Geriatric Psychiatry.

Dietary changes that occur as cognitive impairment progresses into dementia may also make cognitively impaired diabetics more susceptible to hypoglycemia, and memory problems may make compliance difficult, especially when patients have complicated or intensive antidiabetic regimens, she added.

Diabetes is associated with a doubling of the risk of cognitive impairment and dementia, and intensive glycemic control has been shown to significantly decrease the risk of diabetes-associated complications. But the risk/benefit trade-off of intensive glycemic control in cognitively impaired patients has not been studied, the authors stated.

"Recent trials of intensive glycemic control in older patients with diabetes of longer duration showed a lack of benefit and higher rates of hypoglycemia, macrovascular events, and death," they wrote.

They hypothesized that they would find that diabetics with dementia or CI would be managed less aggressively than would cognitively normal diabetics of the same age, but would still have similar rates of hypoglycemia after adjustments.

The investigators tested this idea by conducting a cross-sectional analysis of data on veterans who were treated at Department of Veterans Affairs facilities in fiscal years 2002 and 2003, stratified by coded dementia and cognitive impairment, age, antiglycemic medications, and HbA_1c values.

They found that 18% of the population had a diagnosis of either dementia or cognitive impairment, and that the proportion and distribution of antidiabetic prescriptions were similar among patients with dementia, CI, or neither condition.

They also found that hypoglycemia rates rose with both increasing cognitive impairment and the complexity of the diabetes regimen, yet the mean HbA_1c levels were nearly identical among all three cognitive groups: 7.0% for those with dementia, 6.9% for patients with CI, and 7.0% for those with neither dementia nor CI.

But when the authors looked at the unadjusted odds of hypoglycemia, they found that patients with dementia were more than twice as likely as cognitively normal patients to have hypoglycemia (odds ratio, 2.4), and those with cognitive impairment were likely to have a nearly twofold greater risk of hypoglycemia (OR, 1.7).

Adjustment for potential confounders slightly lowered – but did not eliminate – the excess hypoglycemia in patients with dementia and cognitive impairment (OR, 1.8 and 1.2, respectively).

The study was funded by the VA’s Health Services Research and Development Service. Dr. Feil received a VA Career Development Award.

SAN ANTONIO – Older adults with diabetes who frequently have hypoglycemia may be especially vulnerable to the development of cognitive impairment or dementia, suggest data from a study of nearly half a million veterans.

The findings also suggest that patients aged 65 years and older with diabetes should have cognitive screening, and that there should be increased overall surveillance in this population, according to Dr. Denise G. Feil, a geriatric psychiatrist at the VA Greater Los Angeles Healthcare System, and colleagues.

An examination of the association of antidiabetic treatment with rates of ICD-9-CM–coded hypoglycemia in 497,900 veterans aged 65 years and older with diabetes showed that veterans who had cognitive impairment (CI) or dementia had significantly higher rates of hypoglycemia than did their cognitively intact peers in both adjusted and unadjusted analyses, the researchers reported.

"The risk of hypoglycemia is higher even when their medication regimen is the same and their [hemoglobin A_1c] levels are the same as those of patients without dementia, which suggest that there are social factors that might be different in this patient population. There may be other issues that are neurological, such as whether neuroglycopenia from repeat hypoglycemia is having some kind of effect," said Dr. Feil in an interview at the annual meeting of the American Association for Geriatric Psychiatry.

Dietary changes that occur as cognitive impairment progresses into dementia may also make cognitively impaired diabetics more susceptible to hypoglycemia, and memory problems may make compliance difficult, especially when patients have complicated or intensive antidiabetic regimens, she added.

Diabetes is associated with a doubling of the risk of cognitive impairment and dementia, and intensive glycemic control has been shown to significantly decrease the risk of diabetes-associated complications. But the risk/benefit trade-off of intensive glycemic control in cognitively impaired patients has not been studied, the authors stated.

"Recent trials of intensive glycemic control in older patients with diabetes of longer duration showed a lack of benefit and higher rates of hypoglycemia, macrovascular events, and death," they wrote.

They hypothesized that they would find that diabetics with dementia or CI would be managed less aggressively than would cognitively normal diabetics of the same age, but would still have similar rates of hypoglycemia after adjustments.

The investigators tested this idea by conducting a cross-sectional analysis of data on veterans who were treated at Department of Veterans Affairs facilities in fiscal years 2002 and 2003, stratified by coded dementia and cognitive impairment, age, antiglycemic medications, and HbA_1c values.

They found that 18% of the population had a diagnosis of either dementia or cognitive impairment, and that the proportion and distribution of antidiabetic prescriptions were similar among patients with dementia, CI, or neither condition.

They also found that hypoglycemia rates rose with both increasing cognitive impairment and the complexity of the diabetes regimen, yet the mean HbA_1c levels were nearly identical among all three cognitive groups: 7.0% for those with dementia, 6.9% for patients with CI, and 7.0% for those with neither dementia nor CI.

But when the authors looked at the unadjusted odds of hypoglycemia, they found that patients with dementia were more than twice as likely as cognitively normal patients to have hypoglycemia (odds ratio, 2.4), and those with cognitive impairment were likely to have a nearly twofold greater risk of hypoglycemia (OR, 1.7).

Adjustment for potential confounders slightly lowered – but did not eliminate – the excess hypoglycemia in patients with dementia and cognitive impairment (OR, 1.8 and 1.2, respectively).

The study was funded by the VA’s Health Services Research and Development Service. Dr. Feil received a VA Career Development Award.

SAN ANTONIO – Depression and obesity appear to go hand in hand among community-dwelling older adults, according to Dr. Laura Kersting Barre.

The prevalence of depression among men and women in their 60s, 70s, and 80s rises in tandem with body mass index (BMI), at about 17% for people with a BMI of 30 or greater (obese), compared with about 11% for those with a normal BMI (18.5-24.9), Dr. Barre of Dartmouth Medical School in Hanover, N.H., reported in a poster presentation at the annual meeting of the American Association for Geriatric Psychiatry.

The relative risk for depression among obese seniors receiving care from three different types of community-based settings was about fourfold higher than for seniors with normal weight, she and her associates found.

"When depression and obesity co-occur, they may act synergistically to further reduce functioning and exacerbate outcomes from comorbid medical conditions. In older adults, the association between obesity and depression and the moderators of the relationship remain unclear," she wrote in the poster.

The investigators explored this relationship by analyzing three separate studies of older adults who were receiving prepared meals in their homes or in senior centers (both in Westchester County, N.Y.), and in publicly financed assisted-living homes in the New York City borough of the Bronx.

Clinically significant depression was defined differently in each setting. In the home-meals setting, depression was defined as a score greater than 9 on the depression scale of the Patient Health Questionnaire. In the congregate-meal (senior center) setting, investigators used the Structured Clinical Interview for DSM-IV Disorders major depression scale. In the assisted-living facilities, the authors used the Basis-28 depressive symptoms scale, a modification of the 32-item Behavior and Symptom Identification Scale, which is a patient-reported measure of psychiatric symptoms.

They found that for women and whites of either sex, being overweight (BMI 25-29.9) was associated with a 20%-40% lower prevalence of depression, but being obese was associated with a relative risk of depression of 1.5 in the community center setting, and 2.4 in the assisted-living setting. Among all seniors 60-74 years old in the same settings, the relative risk of depression was 4.0 among those who were obese.

In analyses controlling for potential confounding factors, the association between obesity and depression was modified by sex, age, and race, but not by level of education attained, the authors found.

The investigators acknowledged that the study could not address causality because of its cross-sectional design. In addition, the use of three separate definitions of significant depression limited the investigators’ ability to compare the three different populations.

The study was funded by a National Institute of Mental Health grant to Dr. Barre. The authors reported no other relevant financial disclosures.

SAN ANTONIO – Depression and obesity appear to go hand in hand among community-dwelling older adults, according to Dr. Laura Kersting Barre.

The prevalence of depression among men and women in their 60s, 70s, and 80s rises in tandem with body mass index (BMI), at about 17% for people with a BMI of 30 or greater (obese), compared with about 11% for those with a normal BMI (18.5-24.9), Dr. Barre of Dartmouth Medical School in Hanover, N.H., reported in a poster presentation at the annual meeting of the American Association for Geriatric Psychiatry.

The relative risk for depression among obese seniors receiving care from three different types of community-based settings was about fourfold higher than for seniors with normal weight, she and her associates found.

"When depression and obesity co-occur, they may act synergistically to further reduce functioning and exacerbate outcomes from comorbid medical conditions. In older adults, the association between obesity and depression and the moderators of the relationship remain unclear," she wrote in the poster.

The investigators explored this relationship by analyzing three separate studies of older adults who were receiving prepared meals in their homes or in senior centers (both in Westchester County, N.Y.), and in publicly financed assisted-living homes in the New York City borough of the Bronx.

Clinically significant depression was defined differently in each setting. In the home-meals setting, depression was defined as a score greater than 9 on the depression scale of the Patient Health Questionnaire. In the congregate-meal (senior center) setting, investigators used the Structured Clinical Interview for DSM-IV Disorders major depression scale. In the assisted-living facilities, the authors used the Basis-28 depressive symptoms scale, a modification of the 32-item Behavior and Symptom Identification Scale, which is a patient-reported measure of psychiatric symptoms.

They found that for women and whites of either sex, being overweight (BMI 25-29.9) was associated with a 20%-40% lower prevalence of depression, but being obese was associated with a relative risk of depression of 1.5 in the community center setting, and 2.4 in the assisted-living setting. Among all seniors 60-74 years old in the same settings, the relative risk of depression was 4.0 among those who were obese.

In analyses controlling for potential confounding factors, the association between obesity and depression was modified by sex, age, and race, but not by level of education attained, the authors found.

The investigators acknowledged that the study could not address causality because of its cross-sectional design. In addition, the use of three separate definitions of significant depression limited the investigators’ ability to compare the three different populations.

The study was funded by a National Institute of Mental Health grant to Dr. Barre. The authors reported no other relevant financial disclosures.

SAN ANTONIO – Depression and obesity appear to go hand in hand among community-dwelling older adults, according to Dr. Laura Kersting Barre.

The prevalence of depression among men and women in their 60s, 70s, and 80s rises in tandem with body mass index (BMI), at about 17% for people with a BMI of 30 or greater (obese), compared with about 11% for those with a normal BMI (18.5-24.9), Dr. Barre of Dartmouth Medical School in Hanover, N.H., reported in a poster presentation at the annual meeting of the American Association for Geriatric Psychiatry.

The relative risk for depression among obese seniors receiving care from three different types of community-based settings was about fourfold higher than for seniors with normal weight, she and her associates found.

"When depression and obesity co-occur, they may act synergistically to further reduce functioning and exacerbate outcomes from comorbid medical conditions. In older adults, the association between obesity and depression and the moderators of the relationship remain unclear," she wrote in the poster.

The investigators explored this relationship by analyzing three separate studies of older adults who were receiving prepared meals in their homes or in senior centers (both in Westchester County, N.Y.), and in publicly financed assisted-living homes in the New York City borough of the Bronx.

Clinically significant depression was defined differently in each setting. In the home-meals setting, depression was defined as a score greater than 9 on the depression scale of the Patient Health Questionnaire. In the congregate-meal (senior center) setting, investigators used the Structured Clinical Interview for DSM-IV Disorders major depression scale. In the assisted-living facilities, the authors used the Basis-28 depressive symptoms scale, a modification of the 32-item Behavior and Symptom Identification Scale, which is a patient-reported measure of psychiatric symptoms.

They found that for women and whites of either sex, being overweight (BMI 25-29.9) was associated with a 20%-40% lower prevalence of depression, but being obese was associated with a relative risk of depression of 1.5 in the community center setting, and 2.4 in the assisted-living setting. Among all seniors 60-74 years old in the same settings, the relative risk of depression was 4.0 among those who were obese.

In analyses controlling for potential confounding factors, the association between obesity and depression was modified by sex, age, and race, but not by level of education attained, the authors found.

The investigators acknowledged that the study could not address causality because of its cross-sectional design. In addition, the use of three separate definitions of significant depression limited the investigators’ ability to compare the three different populations.

The study was funded by a National Institute of Mental Health grant to Dr. Barre. The authors reported no other relevant financial disclosures.

SAN ANTONIO – Depression and obesity appear to go hand in hand among community-dwelling older adults, according to Dr. Laura Kersting Barre.

The prevalence of depression among men and women in their 60s, 70s, and 80s rises in tandem with body mass index (BMI), at about 17% for people with a BMI of 30 or greater (obese), compared with about 11% for those with a normal BMI (18.5-24.9), Dr. Barre of Dartmouth Medical School in Hanover, N.H., reported in a poster presentation at the annual meeting of the American Association for Geriatric Psychiatry.

The relative risk for depression among obese seniors receiving care from three different types of community-based settings was about fourfold higher than for seniors with normal weight, she and her associates found.

"When depression and obesity co-occur, they may act synergistically to further reduce functioning and exacerbate outcomes from comorbid medical conditions. In older adults, the association between obesity and depression and the moderators of the relationship remain unclear," she wrote in the poster.

The investigators explored this relationship by analyzing three separate studies of older adults who were receiving prepared meals in their homes or in senior centers (both in Westchester County, N.Y.), and in publicly financed assisted-living homes in the New York City borough of the Bronx.

Clinically significant depression was defined differently in each setting. In the home-meals setting, depression was defined as a score greater than 9 on the depression scale of the Patient Health Questionnaire. In the congregate-meal (senior center) setting, investigators used the Structured Clinical Interview for DSM-IV Disorders major depression scale. In the assisted-living facilities, the authors used the Basis-28 depressive symptoms scale, a modification of the 32-item Behavior and Symptom Identification Scale, which is a patient-reported measure of psychiatric symptoms.

They found that for women and whites of either sex, being overweight (BMI 25-29.9) was associated with a 20%-40% lower prevalence of depression, but being obese was associated with a relative risk of depression of 1.5 in the community center setting, and 2.4 in the assisted-living setting. Among all seniors 60-74 years old in the same settings, the relative risk of depression was 4.0 among those who were obese.

In analyses controlling for potential confounding factors, the association between obesity and depression was modified by sex, age, and race, but not by level of education attained, the authors found.

The investigators acknowledged that the study could not address causality because of its cross-sectional design. In addition, the use of three separate definitions of significant depression limited the investigators’ ability to compare the three different populations.

The study was funded by a National Institute of Mental Health grant to Dr. Barre. The authors reported no other relevant financial disclosures.

SAN ANTONIO – Depression and obesity appear to go hand in hand among community-dwelling older adults, according to Dr. Laura Kersting Barre.

The prevalence of depression among men and women in their 60s, 70s, and 80s rises in tandem with body mass index (BMI), at about 17% for people with a BMI of 30 or greater (obese), compared with about 11% for those with a normal BMI (18.5-24.9), Dr. Barre of Dartmouth Medical School in Hanover, N.H., reported in a poster presentation at the annual meeting of the American Association for Geriatric Psychiatry.

The relative risk for depression among obese seniors receiving care from three different types of community-based settings was about fourfold higher than for seniors with normal weight, she and her associates found.

"When depression and obesity co-occur, they may act synergistically to further reduce functioning and exacerbate outcomes from comorbid medical conditions. In older adults, the association between obesity and depression and the moderators of the relationship remain unclear," she wrote in the poster.

The investigators explored this relationship by analyzing three separate studies of older adults who were receiving prepared meals in their homes or in senior centers (both in Westchester County, N.Y.), and in publicly financed assisted-living homes in the New York City borough of the Bronx.

Clinically significant depression was defined differently in each setting. In the home-meals setting, depression was defined as a score greater than 9 on the depression scale of the Patient Health Questionnaire. In the congregate-meal (senior center) setting, investigators used the Structured Clinical Interview for DSM-IV Disorders major depression scale. In the assisted-living facilities, the authors used the Basis-28 depressive symptoms scale, a modification of the 32-item Behavior and Symptom Identification Scale, which is a patient-reported measure of psychiatric symptoms.

They found that for women and whites of either sex, being overweight (BMI 25-29.9) was associated with a 20%-40% lower prevalence of depression, but being obese was associated with a relative risk of depression of 1.5 in the community center setting, and 2.4 in the assisted-living setting. Among all seniors 60-74 years old in the same settings, the relative risk of depression was 4.0 among those who were obese.

In analyses controlling for potential confounding factors, the association between obesity and depression was modified by sex, age, and race, but not by level of education attained, the authors found.

The investigators acknowledged that the study could not address causality because of its cross-sectional design. In addition, the use of three separate definitions of significant depression limited the investigators’ ability to compare the three different populations.

The study was funded by a National Institute of Mental Health grant to Dr. Barre. The authors reported no other relevant financial disclosures.

SAN ANTONIO – Depression and obesity appear to go hand in hand among community-dwelling older adults, according to Dr. Laura Kersting Barre.

The prevalence of depression among men and women in their 60s, 70s, and 80s rises in tandem with body mass index (BMI), at about 17% for people with a BMI of 30 or greater (obese), compared with about 11% for those with a normal BMI (18.5-24.9), Dr. Barre of Dartmouth Medical School in Hanover, N.H., reported in a poster presentation at the annual meeting of the American Association for Geriatric Psychiatry.

The relative risk for depression among obese seniors receiving care from three different types of community-based settings was about fourfold higher than for seniors with normal weight, she and her associates found.

"When depression and obesity co-occur, they may act synergistically to further reduce functioning and exacerbate outcomes from comorbid medical conditions. In older adults, the association between obesity and depression and the moderators of the relationship remain unclear," she wrote in the poster.

The investigators explored this relationship by analyzing three separate studies of older adults who were receiving prepared meals in their homes or in senior centers (both in Westchester County, N.Y.), and in publicly financed assisted-living homes in the New York City borough of the Bronx.

Clinically significant depression was defined differently in each setting. In the home-meals setting, depression was defined as a score greater than 9 on the depression scale of the Patient Health Questionnaire. In the congregate-meal (senior center) setting, investigators used the Structured Clinical Interview for DSM-IV Disorders major depression scale. In the assisted-living facilities, the authors used the Basis-28 depressive symptoms scale, a modification of the 32-item Behavior and Symptom Identification Scale, which is a patient-reported measure of psychiatric symptoms.

They found that for women and whites of either sex, being overweight (BMI 25-29.9) was associated with a 20%-40% lower prevalence of depression, but being obese was associated with a relative risk of depression of 1.5 in the community center setting, and 2.4 in the assisted-living setting. Among all seniors 60-74 years old in the same settings, the relative risk of depression was 4.0 among those who were obese.

In analyses controlling for potential confounding factors, the association between obesity and depression was modified by sex, age, and race, but not by level of education attained, the authors found.

The investigators acknowledged that the study could not address causality because of its cross-sectional design. In addition, the use of three separate definitions of significant depression limited the investigators’ ability to compare the three different populations.

The study was funded by a National Institute of Mental Health grant to Dr. Barre. The authors reported no other relevant financial disclosures.

SAN ANTONIO – Depression and obesity appear to go hand in hand among community-dwelling older adults, according to Dr. Laura Kersting Barre.

The prevalence of depression among men and women in their 60s, 70s, and 80s rises in tandem with body mass index (BMI), at about 17% for people with a BMI of 30 or greater (obese), compared with about 11% for those with a normal BMI (18.5-24.9), Dr. Barre of Dartmouth Medical School in Hanover, N.H., reported in a poster presentation at the annual meeting of the American Association for Geriatric Psychiatry.

The relative risk for depression among obese seniors receiving care from three different types of community-based settings was about fourfold higher than for seniors with normal weight, she and her associates found.

"When depression and obesity co-occur, they may act synergistically to further reduce functioning and exacerbate outcomes from comorbid medical conditions. In older adults, the association between obesity and depression and the moderators of the relationship remain unclear," she wrote in the poster.

The investigators explored this relationship by analyzing three separate studies of older adults who were receiving prepared meals in their homes or in senior centers (both in Westchester County, N.Y.), and in publicly financed assisted-living homes in the New York City borough of the Bronx.

Clinically significant depression was defined differently in each setting. In the home-meals setting, depression was defined as a score greater than 9 on the depression scale of the Patient Health Questionnaire. In the congregate-meal (senior center) setting, investigators used the Structured Clinical Interview for DSM-IV Disorders major depression scale. In the assisted-living facilities, the authors used the Basis-28 depressive symptoms scale, a modification of the 32-item Behavior and Symptom Identification Scale, which is a patient-reported measure of psychiatric symptoms.

They found that for women and whites of either sex, being overweight (BMI 25-29.9) was associated with a 20%-40% lower prevalence of depression, but being obese was associated with a relative risk of depression of 1.5 in the community center setting, and 2.4 in the assisted-living setting. Among all seniors 60-74 years old in the same settings, the relative risk of depression was 4.0 among those who were obese.

In analyses controlling for potential confounding factors, the association between obesity and depression was modified by sex, age, and race, but not by level of education attained, the authors found.

The investigators acknowledged that the study could not address causality because of its cross-sectional design. In addition, the use of three separate definitions of significant depression limited the investigators’ ability to compare the three different populations.

The study was funded by a National Institute of Mental Health grant to Dr. Barre. The authors reported no other relevant financial disclosures.

SAN ANTONIO – Depression and obesity appear to go hand in hand among community-dwelling older adults, according to Dr. Laura Kersting Barre.

The prevalence of depression among men and women in their 60s, 70s, and 80s rises in tandem with body mass index (BMI), at about 17% for people with a BMI of 30 or greater (obese), compared with about 11% for those with a normal BMI (18.5-24.9), Dr. Barre of Dartmouth Medical School in Hanover, N.H., reported in a poster presentation at the annual meeting of the American Association for Geriatric Psychiatry.

The relative risk for depression among obese seniors receiving care from three different types of community-based settings was about fourfold higher than for seniors with normal weight, she and her associates found.

"When depression and obesity co-occur, they may act synergistically to further reduce functioning and exacerbate outcomes from comorbid medical conditions. In older adults, the association between obesity and depression and the moderators of the relationship remain unclear," she wrote in the poster.

The investigators explored this relationship by analyzing three separate studies of older adults who were receiving prepared meals in their homes or in senior centers (both in Westchester County, N.Y.), and in publicly financed assisted-living homes in the New York City borough of the Bronx.

Clinically significant depression was defined differently in each setting. In the home-meals setting, depression was defined as a score greater than 9 on the depression scale of the Patient Health Questionnaire. In the congregate-meal (senior center) setting, investigators used the Structured Clinical Interview for DSM-IV Disorders major depression scale. In the assisted-living facilities, the authors used the Basis-28 depressive symptoms scale, a modification of the 32-item Behavior and Symptom Identification Scale, which is a patient-reported measure of psychiatric symptoms.

They found that for women and whites of either sex, being overweight (BMI 25-29.9) was associated with a 20%-40% lower prevalence of depression, but being obese was associated with a relative risk of depression of 1.5 in the community center setting, and 2.4 in the assisted-living setting. Among all seniors 60-74 years old in the same settings, the relative risk of depression was 4.0 among those who were obese.

In analyses controlling for potential confounding factors, the association between obesity and depression was modified by sex, age, and race, but not by level of education attained, the authors found.

The investigators acknowledged that the study could not address causality because of its cross-sectional design. In addition, the use of three separate definitions of significant depression limited the investigators’ ability to compare the three different populations.

The study was funded by a National Institute of Mental Health grant to Dr. Barre. The authors reported no other relevant financial disclosures.

SAN ANTONIO – Depression and obesity appear to go hand in hand among community-dwelling older adults, according to Dr. Laura Kersting Barre.

The prevalence of depression among men and women in their 60s, 70s, and 80s rises in tandem with body mass index (BMI), at about 17% for people with a BMI of 30 or greater (obese), compared with about 11% for those with a normal BMI (18.5-24.9), Dr. Barre of Dartmouth Medical School in Hanover, N.H., reported in a poster presentation at the annual meeting of the American Association for Geriatric Psychiatry.

The relative risk for depression among obese seniors receiving care from three different types of community-based settings was about fourfold higher than for seniors with normal weight, she and her associates found.

"When depression and obesity co-occur, they may act synergistically to further reduce functioning and exacerbate outcomes from comorbid medical conditions. In older adults, the association between obesity and depression and the moderators of the relationship remain unclear," she wrote in the poster.

The investigators explored this relationship by analyzing three separate studies of older adults who were receiving prepared meals in their homes or in senior centers (both in Westchester County, N.Y.), and in publicly financed assisted-living homes in the New York City borough of the Bronx.

Clinically significant depression was defined differently in each setting. In the home-meals setting, depression was defined as a score greater than 9 on the depression scale of the Patient Health Questionnaire. In the congregate-meal (senior center) setting, investigators used the Structured Clinical Interview for DSM-IV Disorders major depression scale. In the assisted-living facilities, the authors used the Basis-28 depressive symptoms scale, a modification of the 32-item Behavior and Symptom Identification Scale, which is a patient-reported measure of psychiatric symptoms.

They found that for women and whites of either sex, being overweight (BMI 25-29.9) was associated with a 20%-40% lower prevalence of depression, but being obese was associated with a relative risk of depression of 1.5 in the community center setting, and 2.4 in the assisted-living setting. Among all seniors 60-74 years old in the same settings, the relative risk of depression was 4.0 among those who were obese.

In analyses controlling for potential confounding factors, the association between obesity and depression was modified by sex, age, and race, but not by level of education attained, the authors found.

The investigators acknowledged that the study could not address causality because of its cross-sectional design. In addition, the use of three separate definitions of significant depression limited the investigators’ ability to compare the three different populations.

The study was funded by a National Institute of Mental Health grant to Dr. Barre. The authors reported no other relevant financial disclosures.

SAN ANTONIO – Older Mexican American men are significantly less likely than older white non-Hispanic men to be diagnosed or treated for depression, investigators found in an analysis of preliminary data from the Men’s Health and Aging Study.

Among 109 men who screened positive for depressive symptoms or were treated for depression, 35% of the Mexican American men said a physician or other health care professional had suggested to them that they were depressed, compared with 68% of white non-Hispanic men, Dr. Ladson Hinton, professor of psychiatry and behavioral sciences at the University of California, Davis, said at the annual meeting of the American Association for Geriatric Psychiatry.

Photo credit: Courtesy UC Davis Department of Psychiatry

"They’re not being told that they’re depressed; the diagnosis is actually happening at a much lower frequency among these Mexican American men," he said.

Only 28% of the Mexican American men had received a prescription for depression within the previous year, compared with 68% of white men, and 20% received a prescription for a reported SCID (Structured Clinical Interview for DSM Disorders) depression module, compared with 52% of white non-Hispanics (P less than .001 for both comparisons).

The findings show that significant disparities persist in depression recognition and treatment between older white non-Hispanic men and Hispanic men, Dr. Hinton said. Cultural differences might account for some of the disparity, he said. In fact, the results show that the disparity between non-Hispanic whites and Mexican Americans was similar, whether the latter group spoke primarily Spanish or English.

The Men’s Health and Aging Study (MeHAS) is a cross-sectional primary care–based study designed to identify barriers to, and facilitators of, depression care among depressed older white non-Hispanic and Mexican American men.

Potential participants are screened in primary care practices with a three-item screener, and those with a positive screen, defined as one or more depressive symptoms and/or depression treatment, go on to an in-depth qualitative interview covering major depression within the past year, chronic depression, treatment history, screening for cognitive impairment and psychosis, and demographic questions.

Of 364 men recruited, 49 were identified as depressed without treatment, 40 were depressed and treated, and 20 were identified by virtue of having received depression treatment (treatment-only group).

Among a sample of 338 of the 364 men (151 Mexican American and 187 white non-Hispanics), the frequency of depression was roughly equal, at about 27% for the former and 25% for the latter. But Mexican Americans were significantly less likely to have been treated for depression, at 8% vs. 25% for whites (P less than .01).

When the authors looked at the likelihood of treatment among the 109 patients who screened positive for depression or treatment (46 Mexican American and 63 non-Hispanic whites), they found that the association with ethnicity and lack of treatment held up: Mexican Americans made up a larger proportion of the depressed untreated group, but smaller proportions of both the depressed treated and treatment-only groups.

Looking at correlates of depression treatment, they found that factors significantly associated with not receiving treatment were being Mexican American (P = .001), born in Mexico (P = .005), interviewed in Spanish (P = .001), and having less than a high school education (P = .001).

In a logistic regression analysis controlling for age, education, marital status, and self-rated health, Mexican Americans who preferred English had an odds ratio of .20 (P = .004) for getting depression treatment, compared with white non-Hispanics, and those who preferred Spanish had an odds ratio of .15 (P = .006).

"When we think about disparities in care, policies to improve depression care may not be an effective use of resources without a parallel improvement in quality of care. I think what’s really important from a policy perspective is increasing access for older Hispanics. Simultaneously, once we get people in treatment, we really have to focus on trying to improve the quality of what they get in the primary care setting," Dr. Hinton concluded.

The study is funded by the National Institute of Mental Health. Dr. Hinton said he receives research funding from the NIMH, the Alzheimer’s Foundation, and the Weinberg Foundation.

SAN ANTONIO – Older Mexican American men are significantly less likely than older white non-Hispanic men to be diagnosed or treated for depression, investigators found in an analysis of preliminary data from the Men’s Health and Aging Study.

Among 109 men who screened positive for depressive symptoms or were treated for depression, 35% of the Mexican American men said a physician or other health care professional had suggested to them that they were depressed, compared with 68% of white non-Hispanic men, Dr. Ladson Hinton, professor of psychiatry and behavioral sciences at the University of California, Davis, said at the annual meeting of the American Association for Geriatric Psychiatry.

Photo credit: Courtesy UC Davis Department of Psychiatry

"They’re not being told that they’re depressed; the diagnosis is actually happening at a much lower frequency among these Mexican American men," he said.

Only 28% of the Mexican American men had received a prescription for depression within the previous year, compared with 68% of white men, and 20% received a prescription for a reported SCID (Structured Clinical Interview for DSM Disorders) depression module, compared with 52% of white non-Hispanics (P less than .001 for both comparisons).

The findings show that significant disparities persist in depression recognition and treatment between older white non-Hispanic men and Hispanic men, Dr. Hinton said. Cultural differences might account for some of the disparity, he said. In fact, the results show that the disparity between non-Hispanic whites and Mexican Americans was similar, whether the latter group spoke primarily Spanish or English.

The Men’s Health and Aging Study (MeHAS) is a cross-sectional primary care–based study designed to identify barriers to, and facilitators of, depression care among depressed older white non-Hispanic and Mexican American men.

Potential participants are screened in primary care practices with a three-item screener, and those with a positive screen, defined as one or more depressive symptoms and/or depression treatment, go on to an in-depth qualitative interview covering major depression within the past year, chronic depression, treatment history, screening for cognitive impairment and psychosis, and demographic questions.

Of 364 men recruited, 49 were identified as depressed without treatment, 40 were depressed and treated, and 20 were identified by virtue of having received depression treatment (treatment-only group).

Among a sample of 338 of the 364 men (151 Mexican American and 187 white non-Hispanics), the frequency of depression was roughly equal, at about 27% for the former and 25% for the latter. But Mexican Americans were significantly less likely to have been treated for depression, at 8% vs. 25% for whites (P less than .01).

When the authors looked at the likelihood of treatment among the 109 patients who screened positive for depression or treatment (46 Mexican American and 63 non-Hispanic whites), they found that the association with ethnicity and lack of treatment held up: Mexican Americans made up a larger proportion of the depressed untreated group, but smaller proportions of both the depressed treated and treatment-only groups.

Looking at correlates of depression treatment, they found that factors significantly associated with not receiving treatment were being Mexican American (P = .001), born in Mexico (P = .005), interviewed in Spanish (P = .001), and having less than a high school education (P = .001).

In a logistic regression analysis controlling for age, education, marital status, and self-rated health, Mexican Americans who preferred English had an odds ratio of .20 (P = .004) for getting depression treatment, compared with white non-Hispanics, and those who preferred Spanish had an odds ratio of .15 (P = .006).

"When we think about disparities in care, policies to improve depression care may not be an effective use of resources without a parallel improvement in quality of care. I think what’s really important from a policy perspective is increasing access for older Hispanics. Simultaneously, once we get people in treatment, we really have to focus on trying to improve the quality of what they get in the primary care setting," Dr. Hinton concluded.

The study is funded by the National Institute of Mental Health. Dr. Hinton said he receives research funding from the NIMH, the Alzheimer’s Foundation, and the Weinberg Foundation.

SAN ANTONIO – Older Mexican American men are significantly less likely than older white non-Hispanic men to be diagnosed or treated for depression, investigators found in an analysis of preliminary data from the Men’s Health and Aging Study.

Among 109 men who screened positive for depressive symptoms or were treated for depression, 35% of the Mexican American men said a physician or other health care professional had suggested to them that they were depressed, compared with 68% of white non-Hispanic men, Dr. Ladson Hinton, professor of psychiatry and behavioral sciences at the University of California, Davis, said at the annual meeting of the American Association for Geriatric Psychiatry.

Photo credit: Courtesy UC Davis Department of Psychiatry

"They’re not being told that they’re depressed; the diagnosis is actually happening at a much lower frequency among these Mexican American men," he said.

Only 28% of the Mexican American men had received a prescription for depression within the previous year, compared with 68% of white men, and 20% received a prescription for a reported SCID (Structured Clinical Interview for DSM Disorders) depression module, compared with 52% of white non-Hispanics (P less than .001 for both comparisons).

The findings show that significant disparities persist in depression recognition and treatment between older white non-Hispanic men and Hispanic men, Dr. Hinton said. Cultural differences might account for some of the disparity, he said. In fact, the results show that the disparity between non-Hispanic whites and Mexican Americans was similar, whether the latter group spoke primarily Spanish or English.

The Men’s Health and Aging Study (MeHAS) is a cross-sectional primary care–based study designed to identify barriers to, and facilitators of, depression care among depressed older white non-Hispanic and Mexican American men.

Potential participants are screened in primary care practices with a three-item screener, and those with a positive screen, defined as one or more depressive symptoms and/or depression treatment, go on to an in-depth qualitative interview covering major depression within the past year, chronic depression, treatment history, screening for cognitive impairment and psychosis, and demographic questions.

Of 364 men recruited, 49 were identified as depressed without treatment, 40 were depressed and treated, and 20 were identified by virtue of having received depression treatment (treatment-only group).

Among a sample of 338 of the 364 men (151 Mexican American and 187 white non-Hispanics), the frequency of depression was roughly equal, at about 27% for the former and 25% for the latter. But Mexican Americans were significantly less likely to have been treated for depression, at 8% vs. 25% for whites (P less than .01).

When the authors looked at the likelihood of treatment among the 109 patients who screened positive for depression or treatment (46 Mexican American and 63 non-Hispanic whites), they found that the association with ethnicity and lack of treatment held up: Mexican Americans made up a larger proportion of the depressed untreated group, but smaller proportions of both the depressed treated and treatment-only groups.

Looking at correlates of depression treatment, they found that factors significantly associated with not receiving treatment were being Mexican American (P = .001), born in Mexico (P = .005), interviewed in Spanish (P = .001), and having less than a high school education (P = .001).

In a logistic regression analysis controlling for age, education, marital status, and self-rated health, Mexican Americans who preferred English had an odds ratio of .20 (P = .004) for getting depression treatment, compared with white non-Hispanics, and those who preferred Spanish had an odds ratio of .15 (P = .006).

"When we think about disparities in care, policies to improve depression care may not be an effective use of resources without a parallel improvement in quality of care. I think what’s really important from a policy perspective is increasing access for older Hispanics. Simultaneously, once we get people in treatment, we really have to focus on trying to improve the quality of what they get in the primary care setting," Dr. Hinton concluded.

The study is funded by the National Institute of Mental Health. Dr. Hinton said he receives research funding from the NIMH, the Alzheimer’s Foundation, and the Weinberg Foundation.

SAN ANTONIO – Older Mexican American men are significantly less likely than older white non-Hispanic men to be diagnosed or treated for depression, investigators found in an analysis of preliminary data from the Men’s Health and Aging Study.

Among 109 men who screened positive for depressive symptoms or were treated for depression, 35% of the Mexican American men said a physician or other health care professional had suggested to them that they were depressed, compared with 68% of white non-Hispanic men, Dr. Ladson Hinton, professor of psychiatry and behavioral sciences at the University of California, Davis, said at the annual meeting of the American Association for Geriatric Psychiatry.

Photo credit: Courtesy UC Davis Department of Psychiatry

"They’re not being told that they’re depressed; the diagnosis is actually happening at a much lower frequency among these Mexican American men," he said.

Only 28% of the Mexican American men had received a prescription for depression within the previous year, compared with 68% of white men, and 20% received a prescription for a reported SCID (Structured Clinical Interview for DSM Disorders) depression module, compared with 52% of white non-Hispanics (P less than .001 for both comparisons).

The findings show that significant disparities persist in depression recognition and treatment between older white non-Hispanic men and Hispanic men, Dr. Hinton said. Cultural differences might account for some of the disparity, he said. In fact, the results show that the disparity between non-Hispanic whites and Mexican Americans was similar, whether the latter group spoke primarily Spanish or English.

The Men’s Health and Aging Study (MeHAS) is a cross-sectional primary care–based study designed to identify barriers to, and facilitators of, depression care among depressed older white non-Hispanic and Mexican American men.

Potential participants are screened in primary care practices with a three-item screener, and those with a positive screen, defined as one or more depressive symptoms and/or depression treatment, go on to an in-depth qualitative interview covering major depression within the past year, chronic depression, treatment history, screening for cognitive impairment and psychosis, and demographic questions.

Of 364 men recruited, 49 were identified as depressed without treatment, 40 were depressed and treated, and 20 were identified by virtue of having received depression treatment (treatment-only group).

Among a sample of 338 of the 364 men (151 Mexican American and 187 white non-Hispanics), the frequency of depression was roughly equal, at about 27% for the former and 25% for the latter. But Mexican Americans were significantly less likely to have been treated for depression, at 8% vs. 25% for whites (P less than .01).

When the authors looked at the likelihood of treatment among the 109 patients who screened positive for depression or treatment (46 Mexican American and 63 non-Hispanic whites), they found that the association with ethnicity and lack of treatment held up: Mexican Americans made up a larger proportion of the depressed untreated group, but smaller proportions of both the depressed treated and treatment-only groups.

Looking at correlates of depression treatment, they found that factors significantly associated with not receiving treatment were being Mexican American (P = .001), born in Mexico (P = .005), interviewed in Spanish (P = .001), and having less than a high school education (P = .001).

In a logistic regression analysis controlling for age, education, marital status, and self-rated health, Mexican Americans who preferred English had an odds ratio of .20 (P = .004) for getting depression treatment, compared with white non-Hispanics, and those who preferred Spanish had an odds ratio of .15 (P = .006).

"When we think about disparities in care, policies to improve depression care may not be an effective use of resources without a parallel improvement in quality of care. I think what’s really important from a policy perspective is increasing access for older Hispanics. Simultaneously, once we get people in treatment, we really have to focus on trying to improve the quality of what they get in the primary care setting," Dr. Hinton concluded.

The study is funded by the National Institute of Mental Health. Dr. Hinton said he receives research funding from the NIMH, the Alzheimer’s Foundation, and the Weinberg Foundation.

SAN ANTONIO – Older Mexican American men are significantly less likely than older white non-Hispanic men to be diagnosed or treated for depression, investigators found in an analysis of preliminary data from the Men’s Health and Aging Study.

Among 109 men who screened positive for depressive symptoms or were treated for depression, 35% of the Mexican American men said a physician or other health care professional had suggested to them that they were depressed, compared with 68% of white non-Hispanic men, Dr. Ladson Hinton, professor of psychiatry and behavioral sciences at the University of California, Davis, said at the annual meeting of the American Association for Geriatric Psychiatry.

Photo credit: Courtesy UC Davis Department of Psychiatry

"They’re not being told that they’re depressed; the diagnosis is actually happening at a much lower frequency among these Mexican American men," he said.

Only 28% of the Mexican American men had received a prescription for depression within the previous year, compared with 68% of white men, and 20% received a prescription for a reported SCID (Structured Clinical Interview for DSM Disorders) depression module, compared with 52% of white non-Hispanics (P less than .001 for both comparisons).

The findings show that significant disparities persist in depression recognition and treatment between older white non-Hispanic men and Hispanic men, Dr. Hinton said. Cultural differences might account for some of the disparity, he said. In fact, the results show that the disparity between non-Hispanic whites and Mexican Americans was similar, whether the latter group spoke primarily Spanish or English.

The Men’s Health and Aging Study (MeHAS) is a cross-sectional primary care–based study designed to identify barriers to, and facilitators of, depression care among depressed older white non-Hispanic and Mexican American men.

Potential participants are screened in primary care practices with a three-item screener, and those with a positive screen, defined as one or more depressive symptoms and/or depression treatment, go on to an in-depth qualitative interview covering major depression within the past year, chronic depression, treatment history, screening for cognitive impairment and psychosis, and demographic questions.

Of 364 men recruited, 49 were identified as depressed without treatment, 40 were depressed and treated, and 20 were identified by virtue of having received depression treatment (treatment-only group).

Among a sample of 338 of the 364 men (151 Mexican American and 187 white non-Hispanics), the frequency of depression was roughly equal, at about 27% for the former and 25% for the latter. But Mexican Americans were significantly less likely to have been treated for depression, at 8% vs. 25% for whites (P less than .01).

When the authors looked at the likelihood of treatment among the 109 patients who screened positive for depression or treatment (46 Mexican American and 63 non-Hispanic whites), they found that the association with ethnicity and lack of treatment held up: Mexican Americans made up a larger proportion of the depressed untreated group, but smaller proportions of both the depressed treated and treatment-only groups.

Looking at correlates of depression treatment, they found that factors significantly associated with not receiving treatment were being Mexican American (P = .001), born in Mexico (P = .005), interviewed in Spanish (P = .001), and having less than a high school education (P = .001).

In a logistic regression analysis controlling for age, education, marital status, and self-rated health, Mexican Americans who preferred English had an odds ratio of .20 (P = .004) for getting depression treatment, compared with white non-Hispanics, and those who preferred Spanish had an odds ratio of .15 (P = .006).

"When we think about disparities in care, policies to improve depression care may not be an effective use of resources without a parallel improvement in quality of care. I think what’s really important from a policy perspective is increasing access for older Hispanics. Simultaneously, once we get people in treatment, we really have to focus on trying to improve the quality of what they get in the primary care setting," Dr. Hinton concluded.

The study is funded by the National Institute of Mental Health. Dr. Hinton said he receives research funding from the NIMH, the Alzheimer’s Foundation, and the Weinberg Foundation.

SAN ANTONIO – Older Mexican American men are significantly less likely than older white non-Hispanic men to be diagnosed or treated for depression, investigators found in an analysis of preliminary data from the Men’s Health and Aging Study.

Among 109 men who screened positive for depressive symptoms or were treated for depression, 35% of the Mexican American men said a physician or other health care professional had suggested to them that they were depressed, compared with 68% of white non-Hispanic men, Dr. Ladson Hinton, professor of psychiatry and behavioral sciences at the University of California, Davis, said at the annual meeting of the American Association for Geriatric Psychiatry.

Photo credit: Courtesy UC Davis Department of Psychiatry

"They’re not being told that they’re depressed; the diagnosis is actually happening at a much lower frequency among these Mexican American men," he said.

Only 28% of the Mexican American men had received a prescription for depression within the previous year, compared with 68% of white men, and 20% received a prescription for a reported SCID (Structured Clinical Interview for DSM Disorders) depression module, compared with 52% of white non-Hispanics (P less than .001 for both comparisons).

The findings show that significant disparities persist in depression recognition and treatment between older white non-Hispanic men and Hispanic men, Dr. Hinton said. Cultural differences might account for some of the disparity, he said. In fact, the results show that the disparity between non-Hispanic whites and Mexican Americans was similar, whether the latter group spoke primarily Spanish or English.

The Men’s Health and Aging Study (MeHAS) is a cross-sectional primary care–based study designed to identify barriers to, and facilitators of, depression care among depressed older white non-Hispanic and Mexican American men.

Potential participants are screened in primary care practices with a three-item screener, and those with a positive screen, defined as one or more depressive symptoms and/or depression treatment, go on to an in-depth qualitative interview covering major depression within the past year, chronic depression, treatment history, screening for cognitive impairment and psychosis, and demographic questions.

Of 364 men recruited, 49 were identified as depressed without treatment, 40 were depressed and treated, and 20 were identified by virtue of having received depression treatment (treatment-only group).

Among a sample of 338 of the 364 men (151 Mexican American and 187 white non-Hispanics), the frequency of depression was roughly equal, at about 27% for the former and 25% for the latter. But Mexican Americans were significantly less likely to have been treated for depression, at 8% vs. 25% for whites (P less than .01).

When the authors looked at the likelihood of treatment among the 109 patients who screened positive for depression or treatment (46 Mexican American and 63 non-Hispanic whites), they found that the association with ethnicity and lack of treatment held up: Mexican Americans made up a larger proportion of the depressed untreated group, but smaller proportions of both the depressed treated and treatment-only groups.

Looking at correlates of depression treatment, they found that factors significantly associated with not receiving treatment were being Mexican American (P = .001), born in Mexico (P = .005), interviewed in Spanish (P = .001), and having less than a high school education (P = .001).

In a logistic regression analysis controlling for age, education, marital status, and self-rated health, Mexican Americans who preferred English had an odds ratio of .20 (P = .004) for getting depression treatment, compared with white non-Hispanics, and those who preferred Spanish had an odds ratio of .15 (P = .006).

"When we think about disparities in care, policies to improve depression care may not be an effective use of resources without a parallel improvement in quality of care. I think what’s really important from a policy perspective is increasing access for older Hispanics. Simultaneously, once we get people in treatment, we really have to focus on trying to improve the quality of what they get in the primary care setting," Dr. Hinton concluded.

The study is funded by the National Institute of Mental Health. Dr. Hinton said he receives research funding from the NIMH, the Alzheimer’s Foundation, and the Weinberg Foundation.

SAN ANTONIO – Preventing or treating depression after a stroke can help patients with varying degrees of disability and adaptive skills recover functional ability.

Treatment for depression can help patients develop the plasticity they need to recover physical function, or in the case of more serious poststroke disabilities, help them more readily adapt to their limitations, Dr. Ellen M. Whyte said at the annual meeting of the American Association for Geriatric Psychiatry.

Both the brain’s plasticity and adaptation rely on the ability of patients to practice and learn new skills to help themselves recover or adapt after a major medical illness such as a stroke. But evidence from several studies shows that "depression after a stroke is associated with poor functional recovery and decreased efficiency of recovery," said Dr. Whyte, a geriatric psychiatrist at the University of Pittsburgh.

Decreased Participation. Depression may impede recovery from a stroke by decreasing a patient’s participation in rehabilitation activities, she said. Depression is also associated with cognitive problems, such as executive impairment, that can interfere with recovery or adaptation, and with motor impairment, such as decreased gait speed, which may also hinder rehabilitation.

A 2004 study from the University of Pittsburgh of 242 patients admitted for rehabilitation showed that patients who were "frequent poor participators" in rehabilitation activities had less physical recovery and longer length of stay, and were more likely to be institutionalized than either occasionally poor participators or good participators (Arch. Phys. Med. Rehabil. 2004;85:1599-601).

A separate study by Dr. Whyte and her colleagues looked at the effects of mood, apathy, memory, attention, executive function, and level of disability on participation in rehabilitation. The patients all had evidence of cognitive impairment, but they were without major depression.

The investigators found that among the 44 stroke survivors aged 60 years and older who were admitted for inpatient rehabilitation, baseline disability and impairment of executive function were independent predictors of participation. They also found that "while level of depressive symptoms was not an independent predictor of rehabilitation participation in this sample, it was strongly correlated with executive functions. Depressive symptoms and impairment in executive functions frequently overlap in late lifeand after stroke, and potentially represent ischemic injury to frontal-subcortical pathways" (Arch. Phys. Med. Rehabil. 2010;91:203-7).

Falls and Depression Linked. Other studies found that depression, as measured by the Symptom Checklist-90, was associated with a doubling of falls in community-dwelling adults aged 70 years or older (J. Clin. Epidemiol. 2002;55:1088-94), and that poor self-rated health, poor cognitive status, impaired activities of daily living, two or more clinic visits in the past month, and slow walking speed predicted both an elderly patient’s risk of falling and depressive symptoms (J. Epidemiol. Community Health 2002;56:631-6), she said.

Additionally, investigators looking at the effect of depression remission after a stroke found that patients with remission of a depressive disorder at follow-up had significantly greater recovery in activities of daily living (ADL) functions than did patients without remission. The authors also found that patients with remission of either major or minor depression showed greater improvement in ADL than did patients without remission, some of whom had received the antidepressant nortriptyline, and some of whom had received placebo. The finding suggests that nondrug mechanisms of recovery from depression may have accounted for the improvements in ADL among patients with remission (J. Nerv. Ment. Dis. 2001;189:421-5).

The evidence points to a stroke-recovery model in which preventing or treating depression would lead to increased motivation and participation in rehabilitation programs, reduced depression-related cognitive impairments, and decreases in depression-related motor impairments, Dr. Whyte said.

Dr. Whyte receives research support from the National Center for Medical Rehabilitation Research. She has previously received research support from Eli Lilly, Forest Pharmaceuticals, Ortho-McNeil, Pfizer Pharmaceuticals, and the National Institute of Mental Health.

SAN ANTONIO – Preventing or treating depression after a stroke can help patients with varying degrees of disability and adaptive skills recover functional ability.

Treatment for depression can help patients develop the plasticity they need to recover physical function, or in the case of more serious poststroke disabilities, help them more readily adapt to their limitations, Dr. Ellen M. Whyte said at the annual meeting of the American Association for Geriatric Psychiatry.

Both the brain’s plasticity and adaptation rely on the ability of patients to practice and learn new skills to help themselves recover or adapt after a major medical illness such as a stroke. But evidence from several studies shows that "depression after a stroke is associated with poor functional recovery and decreased efficiency of recovery," said Dr. Whyte, a geriatric psychiatrist at the University of Pittsburgh.

Decreased Participation. Depression may impede recovery from a stroke by decreasing a patient’s participation in rehabilitation activities, she said. Depression is also associated with cognitive problems, such as executive impairment, that can interfere with recovery or adaptation, and with motor impairment, such as decreased gait speed, which may also hinder rehabilitation.

A 2004 study from the University of Pittsburgh of 242 patients admitted for rehabilitation showed that patients who were "frequent poor participators" in rehabilitation activities had less physical recovery and longer length of stay, and were more likely to be institutionalized than either occasionally poor participators or good participators (Arch. Phys. Med. Rehabil. 2004;85:1599-601).

A separate study by Dr. Whyte and her colleagues looked at the effects of mood, apathy, memory, attention, executive function, and level of disability on participation in rehabilitation. The patients all had evidence of cognitive impairment, but they were without major depression.

The investigators found that among the 44 stroke survivors aged 60 years and older who were admitted for inpatient rehabilitation, baseline disability and impairment of executive function were independent predictors of participation. They also found that "while level of depressive symptoms was not an independent predictor of rehabilitation participation in this sample, it was strongly correlated with executive functions. Depressive symptoms and impairment in executive functions frequently overlap in late lifeand after stroke, and potentially represent ischemic injury to frontal-subcortical pathways" (Arch. Phys. Med. Rehabil. 2010;91:203-7).

Falls and Depression Linked. Other studies found that depression, as measured by the Symptom Checklist-90, was associated with a doubling of falls in community-dwelling adults aged 70 years or older (J. Clin. Epidemiol. 2002;55:1088-94), and that poor self-rated health, poor cognitive status, impaired activities of daily living, two or more clinic visits in the past month, and slow walking speed predicted both an elderly patient’s risk of falling and depressive symptoms (J. Epidemiol. Community Health 2002;56:631-6), she said.

Additionally, investigators looking at the effect of depression remission after a stroke found that patients with remission of a depressive disorder at follow-up had significantly greater recovery in activities of daily living (ADL) functions than did patients without remission. The authors also found that patients with remission of either major or minor depression showed greater improvement in ADL than did patients without remission, some of whom had received the antidepressant nortriptyline, and some of whom had received placebo. The finding suggests that nondrug mechanisms of recovery from depression may have accounted for the improvements in ADL among patients with remission (J. Nerv. Ment. Dis. 2001;189:421-5).

The evidence points to a stroke-recovery model in which preventing or treating depression would lead to increased motivation and participation in rehabilitation programs, reduced depression-related cognitive impairments, and decreases in depression-related motor impairments, Dr. Whyte said.

Dr. Whyte receives research support from the National Center for Medical Rehabilitation Research. She has previously received research support from Eli Lilly, Forest Pharmaceuticals, Ortho-McNeil, Pfizer Pharmaceuticals, and the National Institute of Mental Health.

SAN ANTONIO – Preventing or treating depression after a stroke can help patients with varying degrees of disability and adaptive skills recover functional ability.

Treatment for depression can help patients develop the plasticity they need to recover physical function, or in the case of more serious poststroke disabilities, help them more readily adapt to their limitations, Dr. Ellen M. Whyte said at the annual meeting of the American Association for Geriatric Psychiatry.

Both the brain’s plasticity and adaptation rely on the ability of patients to practice and learn new skills to help themselves recover or adapt after a major medical illness such as a stroke. But evidence from several studies shows that "depression after a stroke is associated with poor functional recovery and decreased efficiency of recovery," said Dr. Whyte, a geriatric psychiatrist at the University of Pittsburgh.

Decreased Participation. Depression may impede recovery from a stroke by decreasing a patient’s participation in rehabilitation activities, she said. Depression is also associated with cognitive problems, such as executive impairment, that can interfere with recovery or adaptation, and with motor impairment, such as decreased gait speed, which may also hinder rehabilitation.

A 2004 study from the University of Pittsburgh of 242 patients admitted for rehabilitation showed that patients who were "frequent poor participators" in rehabilitation activities had less physical recovery and longer length of stay, and were more likely to be institutionalized than either occasionally poor participators or good participators (Arch. Phys. Med. Rehabil. 2004;85:1599-601).

A separate study by Dr. Whyte and her colleagues looked at the effects of mood, apathy, memory, attention, executive function, and level of disability on participation in rehabilitation. The patients all had evidence of cognitive impairment, but they were without major depression.

The investigators found that among the 44 stroke survivors aged 60 years and older who were admitted for inpatient rehabilitation, baseline disability and impairment of executive function were independent predictors of participation. They also found that "while level of depressive symptoms was not an independent predictor of rehabilitation participation in this sample, it was strongly correlated with executive functions. Depressive symptoms and impairment in executive functions frequently overlap in late lifeand after stroke, and potentially represent ischemic injury to frontal-subcortical pathways" (Arch. Phys. Med. Rehabil. 2010;91:203-7).

Falls and Depression Linked. Other studies found that depression, as measured by the Symptom Checklist-90, was associated with a doubling of falls in community-dwelling adults aged 70 years or older (J. Clin. Epidemiol. 2002;55:1088-94), and that poor self-rated health, poor cognitive status, impaired activities of daily living, two or more clinic visits in the past month, and slow walking speed predicted both an elderly patient’s risk of falling and depressive symptoms (J. Epidemiol. Community Health 2002;56:631-6), she said.

Additionally, investigators looking at the effect of depression remission after a stroke found that patients with remission of a depressive disorder at follow-up had significantly greater recovery in activities of daily living (ADL) functions than did patients without remission. The authors also found that patients with remission of either major or minor depression showed greater improvement in ADL than did patients without remission, some of whom had received the antidepressant nortriptyline, and some of whom had received placebo. The finding suggests that nondrug mechanisms of recovery from depression may have accounted for the improvements in ADL among patients with remission (J. Nerv. Ment. Dis. 2001;189:421-5).

The evidence points to a stroke-recovery model in which preventing or treating depression would lead to increased motivation and participation in rehabilitation programs, reduced depression-related cognitive impairments, and decreases in depression-related motor impairments, Dr. Whyte said.

Dr. Whyte receives research support from the National Center for Medical Rehabilitation Research. She has previously received research support from Eli Lilly, Forest Pharmaceuticals, Ortho-McNeil, Pfizer Pharmaceuticals, and the National Institute of Mental Health.

SAN ANTONIO – Preventing or treating depression after a stroke can help patients with varying degrees of disability and adaptive skills recover functional ability.

Treatment for depression can help patients develop the plasticity they need to recover physical function, or in the case of more serious poststroke disabilities, help them more readily adapt to their limitations, Dr. Ellen M. Whyte said at the annual meeting of the American Association for Geriatric Psychiatry.

Both the brain’s plasticity and adaptation rely on the ability of patients to practice and learn new skills to help themselves recover or adapt after a major medical illness such as a stroke. But evidence from several studies shows that "depression after a stroke is associated with poor functional recovery and decreased efficiency of recovery," said Dr. Whyte, a geriatric psychiatrist at the University of Pittsburgh.

Decreased Participation. Depression may impede recovery from a stroke by decreasing a patient’s participation in rehabilitation activities, she said. Depression is also associated with cognitive problems, such as executive impairment, that can interfere with recovery or adaptation, and with motor impairment, such as decreased gait speed, which may also hinder rehabilitation.

A 2004 study from the University of Pittsburgh of 242 patients admitted for rehabilitation showed that patients who were "frequent poor participators" in rehabilitation activities had less physical recovery and longer length of stay, and were more likely to be institutionalized than either occasionally poor participators or good participators (Arch. Phys. Med. Rehabil. 2004;85:1599-601).

A separate study by Dr. Whyte and her colleagues looked at the effects of mood, apathy, memory, attention, executive function, and level of disability on participation in rehabilitation. The patients all had evidence of cognitive impairment, but they were without major depression.

The investigators found that among the 44 stroke survivors aged 60 years and older who were admitted for inpatient rehabilitation, baseline disability and impairment of executive function were independent predictors of participation. They also found that "while level of depressive symptoms was not an independent predictor of rehabilitation participation in this sample, it was strongly correlated with executive functions. Depressive symptoms and impairment in executive functions frequently overlap in late lifeand after stroke, and potentially represent ischemic injury to frontal-subcortical pathways" (Arch. Phys. Med. Rehabil. 2010;91:203-7).

Falls and Depression Linked. Other studies found that depression, as measured by the Symptom Checklist-90, was associated with a doubling of falls in community-dwelling adults aged 70 years or older (J. Clin. Epidemiol. 2002;55:1088-94), and that poor self-rated health, poor cognitive status, impaired activities of daily living, two or more clinic visits in the past month, and slow walking speed predicted both an elderly patient’s risk of falling and depressive symptoms (J. Epidemiol. Community Health 2002;56:631-6), she said.

Additionally, investigators looking at the effect of depression remission after a stroke found that patients with remission of a depressive disorder at follow-up had significantly greater recovery in activities of daily living (ADL) functions than did patients without remission. The authors also found that patients with remission of either major or minor depression showed greater improvement in ADL than did patients without remission, some of whom had received the antidepressant nortriptyline, and some of whom had received placebo. The finding suggests that nondrug mechanisms of recovery from depression may have accounted for the improvements in ADL among patients with remission (J. Nerv. Ment. Dis. 2001;189:421-5).

The evidence points to a stroke-recovery model in which preventing or treating depression would lead to increased motivation and participation in rehabilitation programs, reduced depression-related cognitive impairments, and decreases in depression-related motor impairments, Dr. Whyte said.

Dr. Whyte receives research support from the National Center for Medical Rehabilitation Research. She has previously received research support from Eli Lilly, Forest Pharmaceuticals, Ortho-McNeil, Pfizer Pharmaceuticals, and the National Institute of Mental Health.

SAN ANTONIO – Preventing or treating depression after a stroke can help patients with varying degrees of disability and adaptive skills recover functional ability.

Treatment for depression can help patients develop the plasticity they need to recover physical function, or in the case of more serious poststroke disabilities, help them more readily adapt to their limitations, Dr. Ellen M. Whyte said at the annual meeting of the American Association for Geriatric Psychiatry.

Both the brain’s plasticity and adaptation rely on the ability of patients to practice and learn new skills to help themselves recover or adapt after a major medical illness such as a stroke. But evidence from several studies shows that "depression after a stroke is associated with poor functional recovery and decreased efficiency of recovery," said Dr. Whyte, a geriatric psychiatrist at the University of Pittsburgh.

Decreased Participation. Depression may impede recovery from a stroke by decreasing a patient’s participation in rehabilitation activities, she said. Depression is also associated with cognitive problems, such as executive impairment, that can interfere with recovery or adaptation, and with motor impairment, such as decreased gait speed, which may also hinder rehabilitation.

A 2004 study from the University of Pittsburgh of 242 patients admitted for rehabilitation showed that patients who were "frequent poor participators" in rehabilitation activities had less physical recovery and longer length of stay, and were more likely to be institutionalized than either occasionally poor participators or good participators (Arch. Phys. Med. Rehabil. 2004;85:1599-601).

A separate study by Dr. Whyte and her colleagues looked at the effects of mood, apathy, memory, attention, executive function, and level of disability on participation in rehabilitation. The patients all had evidence of cognitive impairment, but they were without major depression.

The investigators found that among the 44 stroke survivors aged 60 years and older who were admitted for inpatient rehabilitation, baseline disability and impairment of executive function were independent predictors of participation. They also found that "while level of depressive symptoms was not an independent predictor of rehabilitation participation in this sample, it was strongly correlated with executive functions. Depressive symptoms and impairment in executive functions frequently overlap in late lifeand after stroke, and potentially represent ischemic injury to frontal-subcortical pathways" (Arch. Phys. Med. Rehabil. 2010;91:203-7).

Falls and Depression Linked. Other studies found that depression, as measured by the Symptom Checklist-90, was associated with a doubling of falls in community-dwelling adults aged 70 years or older (J. Clin. Epidemiol. 2002;55:1088-94), and that poor self-rated health, poor cognitive status, impaired activities of daily living, two or more clinic visits in the past month, and slow walking speed predicted both an elderly patient’s risk of falling and depressive symptoms (J. Epidemiol. Community Health 2002;56:631-6), she said.

Additionally, investigators looking at the effect of depression remission after a stroke found that patients with remission of a depressive disorder at follow-up had significantly greater recovery in activities of daily living (ADL) functions than did patients without remission. The authors also found that patients with remission of either major or minor depression showed greater improvement in ADL than did patients without remission, some of whom had received the antidepressant nortriptyline, and some of whom had received placebo. The finding suggests that nondrug mechanisms of recovery from depression may have accounted for the improvements in ADL among patients with remission (J. Nerv. Ment. Dis. 2001;189:421-5).

The evidence points to a stroke-recovery model in which preventing or treating depression would lead to increased motivation and participation in rehabilitation programs, reduced depression-related cognitive impairments, and decreases in depression-related motor impairments, Dr. Whyte said.

Dr. Whyte receives research support from the National Center for Medical Rehabilitation Research. She has previously received research support from Eli Lilly, Forest Pharmaceuticals, Ortho-McNeil, Pfizer Pharmaceuticals, and the National Institute of Mental Health.

SAN ANTONIO – Preventing or treating depression after a stroke can help patients with varying degrees of disability and adaptive skills recover functional ability.

Treatment for depression can help patients develop the plasticity they need to recover physical function, or in the case of more serious poststroke disabilities, help them more readily adapt to their limitations, Dr. Ellen M. Whyte said at the annual meeting of the American Association for Geriatric Psychiatry.

Both the brain’s plasticity and adaptation rely on the ability of patients to practice and learn new skills to help themselves recover or adapt after a major medical illness such as a stroke. But evidence from several studies shows that "depression after a stroke is associated with poor functional recovery and decreased efficiency of recovery," said Dr. Whyte, a geriatric psychiatrist at the University of Pittsburgh.

Decreased Participation. Depression may impede recovery from a stroke by decreasing a patient’s participation in rehabilitation activities, she said. Depression is also associated with cognitive problems, such as executive impairment, that can interfere with recovery or adaptation, and with motor impairment, such as decreased gait speed, which may also hinder rehabilitation.

A 2004 study from the University of Pittsburgh of 242 patients admitted for rehabilitation showed that patients who were "frequent poor participators" in rehabilitation activities had less physical recovery and longer length of stay, and were more likely to be institutionalized than either occasionally poor participators or good participators (Arch. Phys. Med. Rehabil. 2004;85:1599-601).

A separate study by Dr. Whyte and her colleagues looked at the effects of mood, apathy, memory, attention, executive function, and level of disability on participation in rehabilitation. The patients all had evidence of cognitive impairment, but they were without major depression.

The investigators found that among the 44 stroke survivors aged 60 years and older who were admitted for inpatient rehabilitation, baseline disability and impairment of executive function were independent predictors of participation. They also found that "while level of depressive symptoms was not an independent predictor of rehabilitation participation in this sample, it was strongly correlated with executive functions. Depressive symptoms and impairment in executive functions frequently overlap in late lifeand after stroke, and potentially represent ischemic injury to frontal-subcortical pathways" (Arch. Phys. Med. Rehabil. 2010;91:203-7).

Falls and Depression Linked. Other studies found that depression, as measured by the Symptom Checklist-90, was associated with a doubling of falls in community-dwelling adults aged 70 years or older (J. Clin. Epidemiol. 2002;55:1088-94), and that poor self-rated health, poor cognitive status, impaired activities of daily living, two or more clinic visits in the past month, and slow walking speed predicted both an elderly patient’s risk of falling and depressive symptoms (J. Epidemiol. Community Health 2002;56:631-6), she said.

Additionally, investigators looking at the effect of depression remission after a stroke found that patients with remission of a depressive disorder at follow-up had significantly greater recovery in activities of daily living (ADL) functions than did patients without remission. The authors also found that patients with remission of either major or minor depression showed greater improvement in ADL than did patients without remission, some of whom had received the antidepressant nortriptyline, and some of whom had received placebo. The finding suggests that nondrug mechanisms of recovery from depression may have accounted for the improvements in ADL among patients with remission (J. Nerv. Ment. Dis. 2001;189:421-5).

The evidence points to a stroke-recovery model in which preventing or treating depression would lead to increased motivation and participation in rehabilitation programs, reduced depression-related cognitive impairments, and decreases in depression-related motor impairments, Dr. Whyte said.

Dr. Whyte receives research support from the National Center for Medical Rehabilitation Research. She has previously received research support from Eli Lilly, Forest Pharmaceuticals, Ortho-McNeil, Pfizer Pharmaceuticals, and the National Institute of Mental Health.