This study explored the links between childhood trauma, depression, adult cognitive functioning and risk of dementia.
Depression has been found to occur in half of individuals given a diagnosis of Alzheimer’s disease (AD). While evidence suggests depression may be a risk factor for AD, there is also suggestion that depression is a symptom of the disease itself. The exact mechanism behind the association between depression and AD is unknown. However, it is thought the common brain changes associated with childhood trauma, including reduced development of the hippocampus and amygdala and abnormal frontotemporal electrical activity, may play a significant role.
The current study used data from 378 PREVENT participants, from West London, Oxford and Cambridge, to investigate whether midlife adults with a history of childhood trauma had greater risk of both depression, loss of hippocampal volume at midlife and in turn, cognitive performance, and risk of dementia.
It was hypothesised that childhood trauma would be associated with greater clinical depression, lower hippocampal volume and poorer cognitive performance and dementia risk at mid-life. However, while childhood trauma was associated with depression and reduced hippocampal volume, it was not related to current cognitive function or dementia risk.
The findings suggest that the aetiology of depression is different to that of dementia, and the relationship of depression to dementia risk in persons experiencing childhood trauma appears to be neither a risk factor nor a prodromal feature of the disease but that of a comorbidity which may add to brain burden. This study demonstrates that theremay be multiple routes to which depression may appear in individuals with high risk of dementia, and future research in this area should take into account the origins of variety of depression symptomatology.
Key terms and abbreviations:
Aetiology = The cause of a disease
AD = Alzheimer’s disease
Comorbidity = The simultaneous presence of two or more diseases or conditions in one individual.
Associations between midlife chronic conditions and medication use with anxiety and depression: A cross-sectional analysis of the PREVENT Dementia study
Lucy E Stirland , Sarah Gregory, Tom C Russ, Craig W Ritchie, Graciela Muniz-Terrera
Journal of Comorbidity. 2020 10.1177/1471301218789307
Summary
There is evidence to suggest that brain health is associated with multimorbidity, polypharmacy, depression and anxiety. This study aimed to investigate the interactions between these four-potential dementia-risk factors (depression, anxiety, multimorbidity and polypharmacy) at mid-life.
By analysing data from our London site’s baseline measures, we discovered that having more chronic physical conditions (multimorbidity) was associated with both depression and anxiety in midlife. However, taking more medications (polypharmacy) was only associated with depression, not anxiety.
These findings highlight an interaction between physical health, medication and mental health at midlife. By following participants further over time and evaluating this interaction we may be able to use this information to inform mental and physical health strategies that may possibly prevent dementia in later life.
Research participants as collaborators: Background, experience and policies from the PREVENT Dementia and EPAD programmes
Sarah Gregory, Katie Wells, Kate Forysth, Cate Latto, Helen Szyra, Stina Saunders, Craig W Ritchie, Richard Milne
Dementia Journal. 2018
10.1177/1471301218789307
Perspectives on Communicating Biomarker-Based Assessments of Alzheimer’s Disease to Cognitively Healthy Individuals.
Milne R, Bunnik E, Diaz A, Richard E, Badger S, Gove D, Georges J, Fauria K, Molinuevo JL, Wells K, Ritchie C.
Journal of Alzheimer’s Disease. 2018
10.3233/JAD-170813
PREVENT participants took part in organised group discussions around the benefits, harms and rights of an individual finding out information from biological measurements that may inform their personal risk of Alzheimer’s disease.
Research into Alzheimer’s disease is increasingly focusing on measuring biological markers in the blood, brain and spinal fluid that may reflect early underlying changes in brain health, so called biomarkers. With the discovery and development of biomarkers that may inform an individual’s level of risk for Alzheimer’s disease comes important new ethical considerations. Whilst the accuracy of these biomarkers still need much refinement, weighing up the harms, benefits and rights of risk disclosure to healthy adults will also require much careful consideration before implementing guidelines into care. With the increasing use of such biomarkers in research however, discussions of how best to communicate the value of these results have come to the fore. Central to the decisions of how to manage these discussions has to be the view of patients and research participants.
Focus groups featuring PREVENT participants as well as people living with dementia were held to establish the attitudes and desires of those individuals for who disclosure of such risk information is most pertinent. This publication summarises the opinions voiced in those group discussions around areas such as how best to clearly disclose information and the type of support that should be made available after learning personalised results.
At, with and beyond risk: expectations of living with the possibility of future dementia.
Milne R, Diaz A, Badger S, Bunnik E, Fauria K, Wells K.
Sociology of health & illness. 2017.
10.1111/1467-9566.12731
Focus groups were held with PREVENT participants to develop discussions around disclosure of dementia risk.
As research into novel treatments for dementia shifts towards earlier intervention and greater understanding of risk factors in a younger population, this generates important new issues of how best to manage risk disclosure. What are the implications of an individual learning their dementia risk? How should this best be communicated? And how might this impact on future life decisions?
To explore these types of questions researchers held focus groups with PREVENT participants to gather opinion on the consequences of these new topics. The discussions centred around the groups expectations on discovering test results that may have implications for risk of future dementia. The three key areas under discussion were; ‘Living At Risk’ – taking proactive steps to reduce risk, ‘Living With Risk’ – maximising cognitive health and accessing healthcare services and ‘Living Beyond Risk’ – planning for later life and adjustment to symptoms.
The PREVENT research programme–a novel research programme to identify and manage midlife risk for dementia: the conceptual framework.
Ritchie CW, Wells K, Ritchie K.
International Review of Psychiatry. 2013
10.3109/09540261.2013.869195
This article outlines the vision of the PREVENT study and how, through in depth study of people in their mid-life, PREVENT can generate novel evidence to inform future interventional trials and improve future care.
Advances in research have helped form our current understanding that the earliest brain changes relating to Alzheimer’s disease occur many years before the emergence of any symptoms. This paper highlights the unmet need for measurable markers that can inform us of an individual’s risk profile for later life dementia.
The authors provide a detailed breakdown of the main aims of the PREVENT programme and introduce the methods used to collect the wide range of information from volunteers. They speculate how knowledge gained from PREVENT and other similar studies can shape future prevention strategies to delay or halt the progression of Alzheimer’s disease.