Mechanisms and treatment of late-life depression
Open accessAbstract
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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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”
From Neurocognitive effects of theta burst stimulation for treatment-resistant depression in adults: A systematic review and recommendations for future research (2025) · cites this paper as Alexopoulos, 2021
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Self-citation
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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
- PMC
- PMC8475935
- 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
- green
- www.ncbi.nlm.nih.gov
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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