Publications by authors named "Helen Lavretsky"

Current clinical practice guidelines were established by several organizations to guide the diagnosis and treatment of hypertension in men and women in a similar manner despite data demonstrating differences in underlying mechanisms. Few publications have provided a contemporary and comprehensive review focused on characteristics of hypertension that are unique to women across their life spectrum. We performed a computerized search using PubMed, OVID, EMBASE, and Cochrane library databases between 1995 and 2023 that highlighted relevant clinical studies, challenges to the management of hypertension in women, and multidisciplinary approaches to hypertension control in women, including issues unique to racial and ethnic minority groups.

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Approximately 7% of COVID-19 patients (1.3% children) have exhibited symptoms of post-acute sequelae of SARS-CoV-2 infection (PASC), or Long COVID, and 20% of those present with neuropsychiatric symptoms. While a large number of MRI-based neuroimaging studies in this population have shown cortical atrophy in terms of gray matter volume and cortical thickness in patients, there is a growing body of work showing brain volume enlargements or thickness increases in patients compared to COVID negative controls.

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As the numbers of older adults continue to increase globally, the need for facilitating healthy aging has become critical. While a physically healthy lifestyle, including exercise and diet, is important, recent research has highlighted a major impact of psychosocial determinants of health, such as resilience, wisdom, positive social connections, and mental well-being, on whole health. This article focuses on keeping the mind and brain healthy with psychosocially active aging.

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Article Synopsis
  • * Concerns are raised about purely biological definitions being used in clinical settings, especially since many biomarker-positive but cognitively normal individuals may never develop symptoms, complicating diagnosis and patient understanding.
  • * The authors advocate for a combined clinical-biological definition of AD that accommodates at-risk and presymptomatic stages, emphasizing the need for caution in diagnosing AD without fully understanding the implications for patients.
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  • Major depressive disorder in older adults (late-life depression) often leads to cognitive impairment, particularly in executive function, which may contribute to treatment resistance.
  • This study analyzed baseline cognitive data from 369 older participants in a clinical trial to understand the relationship between cognitive deficits and the effectiveness of pharmacotherapy for treatment-resistant late-life depression.
  • The findings revealed that participants exhibited significant challenges in inhibitory control and processing speed, with deficits in set shifting specifically predicting poorer response to treatment, indicating a need for tailored therapeutic approaches.
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Background: Adults with treatment-resistant late-life depression (TRLLD) have high rates of sleep problems; however, little is known about the occurrence and change in sleep during pharmacotherapy of TRLLD. This analysis examined: (1) the occurrence of insufficient sleep among adults with TRLLD; (2) how sleep changed during pharmacotherapy; and (3) whether treatment outcomes differed among participants with persistent insufficient sleep, worsened sleep, improved sleep, or persistent sufficient sleep.

Methods: Secondary analysis of data from 634 participants age 60+ years in the OPTIMUM clinical trial for TRLLD.

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Importance: Chronic symptoms reported following an infection with SARS-CoV-2, such as cognitive problems, overlap with symptoms included in the definition of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

Objective: To evaluate the prevalence of ME/CFS-like illness subsequent to acute SARS-CoV-2 infection, changes in ME/CFS symptoms through 12 months of follow-up, and the association of ME/CFS symptoms with SARS-CoV-2 test results at the acute infection-like index illness.

Design, Setting, And Participants: This prospective, multisite, longitudinal cohort study (Innovative Support for Patients with SARS-CoV-2 Infections Registry [INSPIRE]) enrolled participants from December 11, 2020, to August 29, 2022.

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Background: The Patient Health Questionnaire (PHQ-9) and Montgomery-Asberg Depression Rating Scale (MADRS) are commonly used scales to measure depression severity in older adults.

Methods: We utilized data from the Optimizing Outcomes of Treatment-Resistant Depression in Older Adults (OPTIMUM) clinical trial to produce conversion tables relating PHQ-9 and MADRS total scores. We split the sample into training (N = 555) and validation samples (N = 187).

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Introduction: Alcohol and substance use are increasing in older adults, many of whom have depression, and treatment in this context may be more hazardous. We assessed alcohol and other substance use patterns in older adults with treatment-resistant depression (TRD). We examined patient characteristics associated with higher alcohol consumption and examined the moderating effect of alcohol on the association between clinical variables and falls during antidepressant treatment.

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Human immunodeficiency virus (HIV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cause significant neurologic disease. Central nervous system (CNS) involvement of HIV has been extensively studied, with well-documented invasion of HIV into the brain in the initial stage of infection, while the acute effects of SARS-CoV-2 in the brain are unclear. Neuropathologic features of active HIV infection in the brain are well characterized whereas neuropathologic findings in acute COVID-19 are largely non-specific.

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Objective: Biofeedback is a therapeutic treatment model that teaches self-regulation of autonomic functions to alleviate stress-related symptoms. "Long COVID" refers to chronic physical and cognitive sequelae post-SARS-CoV-2 infection. This study examined the efficacy of a six-week intervention, consisting of weekly one-hour sessions combining heart rate variability and temperature biofeedback, for alleviating mood symptoms, somatic symptoms and sleep disturbance of patients diagnosed with long COVID.

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Subjective cognitive decline (SCD) and mild cognitive impairment (MCI) accompanied by cerebrovascular risk factors (CVRFs) are known to increase the risk of developing dementia. Mind-body practices such as yoga and meditation, have been recognized as safe techniques with beneficial effects on cognitive functions in older adults at risk for cognitive decline. We conducted a randomized, controlled trial to assess the efficacy of Kundalini yoga training (KY) compared to memory enhancement training (MET) on mood and cognitive functioning in a group of older women with CVRFs and SCD (clinicaltrials.

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Integrative medicine takes a holistic approach because it considers multiple aspects of the individual. This includes a person's physical, emotional, interpersonal, behavioral, nutritional, environmental, and spiritual dimensions of wellbeing that contribute to the Whole Person Health. There is increasing interest and popularity of integrative approaches to treating cognitive decline and dementia because of the multifactorial nature of aging and the limited pharmacological interventions available in treating cognitive decline and dementia, particularly Alzheimer's disease, the most common type of dementia.

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Objectives: Geriatric depression (GD) is associated with cognitive impairment and brain atrophy. Tai-Chi-Chih (TCC) is a promising adjunct treatment to antidepressants. We previously found beneficial effects of TCC on resting state connectivity in GD.

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Article Synopsis
  • * A scoping review analyzed 11 meta-analyses and systematic reviews, indicating that while social network size and marital status may influence cognitive function, the connection between social support and reduced dementia risk is less convincing.
  • * Technology-based and other interventions aimed at reducing loneliness can enhance social activities and quality of life for individuals with dementia, but they do not seem to significantly improve cognitive function.
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This position statement of the Expert Panel on Brain Health of the American Association for Geriatric Psychiatry (AAGP) emphasizes the critical role of life course brain health in shaping mental well-being during the later stages of life. Evidence posits that maintaining optimal brain health earlier in life is crucial for preventing and managing brain aging-related disorders such as dementia/cognitive decline, depression, stroke, and anxiety. We advocate for a holistic approach that integrates medical, psychological, and social frameworks with culturally tailored interventions across the lifespan to promote brain health and overall mental well-being in aging adults across all communities.

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Background: Yoga may be an ideal early intervention for those with modifiable risk factors for Alzheimer's disease (AD) development.

Objective: To examine the effects of Kundalini yoga (KY) training versus memory enhancement training (MET) on the resting-state connectivity of hippocampal subregions in women with subjective memory decline and cardiovascular risk factors for AD.

Methods: Participants comprised women with subjective memory decline and cardiovascular risk factors who participated in a parent randomized controlled trial (NCT03503669) of 12-weeks of KY versus MET and completed pre- and post-intervention resting-state magnetic resonance imaging scans (yoga: n = 11, age = 61.

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Article Synopsis
  • - The study investigates the links between brain structure (gray matter volume), depression, and resilience in older adults with major depressive disorder, highlighting the significance of resilience as a protective factor.
  • - Involving 49 adults over 60 years old, the research found that higher depression severity correlates with increased anxiety and apathy, but lower resilience; brain scans indicated that larger gray matter volume is associated with improved resilience and reduced anxiety/apathy.
  • - The findings suggest that enhanced gray matter in certain brain regions may serve as a marker for resilience in geriatric depression, indicating potential areas for therapeutic interventions aimed at alleviating depressive symptoms.
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