In This Issue

Hendrie (pg. 480) proposes that international comparativestudies on dementia offer significant advantages for risk factorresearch by providing wider diversity. Their success dependsupon establishing strong academic partnerships, constructingculture fair instruments and establishing a broadly based sci-entific paradigm which can incorporate genetic as well asenvironmental influences.

Cooper et al. (pg. 489) investigated the prevalence and riskfactors for elder abuse in nearly 4,000 older adults receivinghealth and social services in 11 European countries, using theMinimum Dataset Homecare (MDS-HC) interview, which in-cludes an abuse screen. About 5% of people assessed had atleast one indicator of abuse. Factors associated with screeningpositive included greater severity of cognitive impairment,depression, delusions, and living in Italy or Germany. Wediscuss implications for service configuration and delivery.

Clinicians assessing older adults with clinically significantdepressive symptoms typically assess patient specific (or in-dividual) characteristics. Hybels et al. (pg. 498) examinedwhether sociodemographic contextual factors, such as thepoverty level or residential stability of the neighborhood, arealso associated with these symptoms. In this sample, anyobserved association between neighborhood sociodemo-graphic characteristics and individual depressive symptomsappears to reflect the characteristics of the individuals whoreside in the neighborhood rather than these sociodemo-graphic neighborhood factors.

There have been few epidemiological studies of phobia inolder adults. This study examined a multiracial sample of1,074 persons aged 55 and over living in Brooklyn, NY. Cohenet al. (pg. 507) found that 8.9% of the sample met criteria for acurrent phobia and 10.2% met criteria for a lifetime phobia.Consistent with earlier studies, there were strong associationsamong phobia, depressive symptoms, and physical illness.However, early life experiences, income, and coping strategiesand beliefs were also associated with the prevalence of phobia.

Agoraphobia has been reported to be fairly common amongolder adults, but little is known about its epidemiology. Thisstudy by McCabe et al (pg. 515) examines the distribution ofthe disorder among older respondents (55�) in a large Cana-dian survey. Prevalence is 0.61%, which is lower than inprevious studies. Statistical analysis indicates that agorapho-bia is more common among women, younger (55–65) people,those widowed or divorced, and those with comorbid physicaland psychiatric conditions. Concurrent panic disorder is un-common.

Depression and cardiac diseases often co-occur and athero-sclerosis might be the common denominator. Bremmer et al.(pg. 523) followed 2,403 participants of the Longitudinal Ag-ing Study Amsterdam to investigate whether depression isassociated with an increased risk of first cardiac events. Thosewith depression had a doubled risk of first cardiac events,irrespective of their physical health status at baseline. The riskwas entirely due to ischaemic cardiac diseases, implicatingthat depression might be associated with atherosclerosis.

The “vascular depression hypothesis” conceptualizes late on-set depression as a neurological disorder. In our population-based case-control study focal brain lesions, brain atrophy andrisk factors for vascular disease were correlated with cognitionand depression status. Rainer et al. (pg. 531) found no supportfor the “vascular depression hypothesis.” Not cerebrovascularlesion scores but measures of cortical atrophy and medialtemporal lobe atrophy were associated with depression. Brainatrophy may be a new aspect of an “organic etiology oflate-onset depression.”

Small et al. (pg. 538) studied the effects of a 14-day healthylongevity lifestyle program on cognition and cerebral metab-olism in people with mild age-related memory complaints.Volunteers who completed the program combining a brainhealthy diet plan, relaxation exercises, cardiovascular condi-tioning, and mental exercise objectively demonstrated greaterword fluency, and their positron emission tomography scansidentified a 5% decline in glucose metabolism, suggestinggreater cognitive efficiency of a brain region involved in work-ing memory.

Pain and depression are both important public health prob-lems in older adults. Calabrese et al. (pg. 546) examinedwhether a personality trait known as neuroticism affects therelationship between pain and depression in a group of 404primary care patients age 65 years or older. As hypothesized,pain was independently associated with depression. The ad-ditional risk for depression conferred by pain was particularlystrong in persons who were previously at lower risk for de-pression on account of low neuroticism.

Do different depressive symptoms improve simultaneouslywith acute treatment? Dombrovski et al. (pg. 550) comparedthe speed of improvement in core mood symptoms, sleep, andanxiety in 470 older depressed patients. Anxiety symptomsimproved more slowly than core mood symptoms with anti-depressant monotherapy and with combined pharmacother-apy plus psychotherapy. They found no such difference be-tween sleep and core mood symptoms. Further research needsto address the nature, consequences, and potential treatmentfor persistent anxiety.