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. 2022 Mar 8:13:839012.
doi: 10.3389/fpsyt.2022.839012. eCollection 2022.

Interactive Effects of Agitation and Cognitive Impairment on Odor Identification in Patients With Late-Life Depression

Si Zhang  1 , Ben Chen  1 , Xiaomei Zhong  1 , Min Zhang  1 , Qiang Wang  1 , Zhangying Wu  1 , Le Hou  2 , Huarong Zhou  2 , Xinru Chen  2 , Meiling Liu  1 , Mingfeng Yang  1 , Gaohong Lin  1 , Thomas Hummel  3 , Yuping Ning  1   4   5
Affiliations

Interactive Effects of Agitation and Cognitive Impairment on Odor Identification in Patients With Late-Life Depression

Si Zhang et al. Front Psychiatry. .

Abstract

Background: Late-life depression (LLD) is a risk factor for cognitive decline in older adults, and odor identification (OI) deficits are an early indicator of cognitive decline with LLD. However, neuropsychiatric symptoms (NPSs) are common in LLD and are associated with OI deficits. In subjects with LLD, when OI deficits forecast cognitive decline, whether and how NPS affects the relationship between OI and cognition still must be further explored.

Objective: To comprehensively explore the potential effects of various NPSs on the relationship between OI and cognition in participants with LLD.

Methods: There were 167 patients with LLD and 105 normal elderly (NE) participants. The odor identification test (Sniffin' Sticks), cognitive function assessments (global cognition, memory, executive function, attention, language, visual space), and an NPS assessment (the neuropsychiatric inventory questionnaire) were performed on the subjects. In patients with LLD, the relationship among OI, cognition and NPSs was examined using correlation analysis and moderation analysis.

Results: In patients with LLD, OI was positively correlated with cognition (global cognition, memory, executive function, attention, language) and negatively associated with NPSs (agitation and aberrant motor behavior). In NE group, OI was correlated with executive function. Moderation analysis showed that there was an interactive effect of agitation and cognitive impairment (language deficit or attention deficit) on OI in patients with LLD.

Conclusion: The coexistence of agitation and language or attention deficit was associated with worse OI in subjects with LLD. Agitation should be considered since OI predicts cognitive decline in patients with LLD.

Keywords: Alzheimer's disease; agitation; cognition; late-life depression; neuropsychiatric symptoms; odor identification.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Correlations among OI, cognitive scores and NPI scores. In the NE group, OI was correlated with 1/TMTA (r = 0.231, p = 0.020) and 1/TMTB (r = 0.212, p = 0.034). In the LLD group, OI was correlated with MMSE (r = 0.369, p < 0.001), AVLT N1-N5 total (r = 0.351, p < 0.001), 1/TMTA (r = 0.184, p = 0.025), 1/TMTB (r = 0.195, p = 0.019), VFT (r = 0.288, p < 0.001), and DST (r = 0.220, p = 0.007); OI was correlated with NPI scores, including agitation (r = −0.200, p = 0.010) and aberrant motor behavior (r = −0.165, p = 0.035). LLD, late-life depression; NE, normal elderly; MMSE, Mini-Mental State Examination; AVLT, Auditory Verbal Learning; TMT, Trail-Making Test; VFT, Verbal Fluency Test; DST, Digital Span Test.
Figure 2
Figure 2
The moderating effect of agitation and VFT on OI with LLD. (A) The interactive model among agitation, VFT and OI. There is an interactive effect of VFT*Agitation (β = 0.054, p = 0.012) on OI. (B) When agitation increased from low (−1 SD; B = 0.108) to high (+1 SD; B = 0.305) values, the positive association between VFT and OI became significantly stronger by follow-up simple slope analysis. LLD, late-life depression; VFT, Verbal Fluency Test; OI, odor identification.
Figure 3
Figure 3
The interactive effect of agitation and DST on OI with LLD. (A) The interactive model among agitation, DST and OI. There is an interactive effect of DST*Agitation (β = 0.085, p = 0.027) on OI. (B) When agitation increased from low (−1 SD; B = 0.134) to high (+1 SD; B = 0.440) values, the positive association between DST and OI became significantly stronger by follow-up simple slopes analysis. DST, Digital Span Test; OI, odor identification; LLD, late-life depression.
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