Cited by 22Treatment of Major DepressionTranscranial Magnetic Stimulation StudiesDementia and Cognitive Impairment Research

Mechanisms and treatment of late-life depression

Open access
Alexopoulos, George S.·2021·Focus

Abstract

Depression predisposes to medical illnesses and advances biological aging indicated by shorter telomere length, accelerated brain aging and advanced epigenetic aging. Medical illnesses also increase the risk of late-life depression. The reciprocal relationships of depression with aging-related and disease-related processes have generated pathogenetic hypotheses and provided treatment targets. Targeting risk factors of vascular disease in mid-life is a logical approach in prevention of vascular depression. The depression-executive dysfunction and the vascular depression syndromes have clinical presentations and neuroimaging findings consistent with frontostriatal abnormalities. Dopamine D2/3 agonists are effective in depression of Parkinson’s disease and their efficacy needs to be assessed in these two syndromes. Computerized cognitive remediation targeting functions of the cognitive control network may improve both executive functions and depressive symptoms of late-life major depression. Significant progress has been made in neurostimulation treatments in depressed younger adults. TMS targeting deep structures responsible for mood regulation is well tolerated by older adults and its efficacy in syndromes of late-life depression needs to be studied. Efficacious psychotherapies for late-life depression exist, but are underutilized in part because of their complexity. Streamlined, stepped psychotherapies targeting behaviors assumed to result from dysfunction of brain networks i…

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Registry

Crossref · 10.1176/appi.focus.19304

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194 of 194 references verified0 citation errors · 0 not checkable

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  • Evidence varies regarding the domain most impacted by depression across the lifespan and includes executive function, processing speed, and verbal memory.

    “Although some have demonstrated that individuals experiencing depression perform worse across all neurocognitive domains (e.g., Bora et al., 2013;Parkinson et al., 2020), evidence varies regarding the domain most impacted by depression across the lifespan and include executive function (Alexopoulos, 2021), processing speed (Göke et al., 2024), and verbal memory (Bora et al., 2013;Goodall et al., 2”

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Authors
Alexopoulos, G. S.
Affiliations
Cornell University (US)
Corresponding author
Alexopoulos, George S.
Venue
Focus
Published
2021-07
Volume
19
Issue
3
Pages
340-354
ISSN
  • 1541-4094 (ISSN-L)
  • 1541-4108
OpenAlex
W3195750104
Cited by
22
References
194
Citations by year
2026: 9 · 2025: 4 · 2024: 4 · 2023: 4 · 2022: 1
FWCI
1.31
Type
journal article
Language
en
Open access
Locations
  • FOCUS The Journal of Lifelong Learning in Psychiatry (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
Keywords
geriatric depression, vascular depression, telomere length, epigenetic aging, brain aging, executive dysfunction, Parkinson's disease, cognitive remediation, transcranial magnetic stimulation, psychotherapy, dementia risk, antidepressants, comorbidities

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