insights

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As patients age, environmental, social, and lifestyle factors may begin to affect them in different ways, and their health goals and priorities may shift. Geriatric depression is an increasingly common condition in this population that can stem from drastic changes in social structure, personal relationships, and the inevitable reality of growing older. One study notes that while depressive symptoms from middle age to old age are generally stable, geriatric depression is marked by qualitative differences in how these symptoms manifest. Traditional depression screening may not be as effective in identifying illness as depressive symptoms may be dismissed as a residual effect of other comorbid health problems.¹

A recent cross-sectional study of 114 Jewish older adults living in Israel found that chronic stressors affected age subgroups in disproportionate ways.² Exposure to chronic stressors in the oldest subgroup of those 82-91 years of age was significantly associated with depressive symptoms compared to those in the 65-72 age group. The study also found that the younger subgroup was more engaged in coping strategies than their older counterparts, suggesting that stress management techniques may attenuate the severity of depression symptoms as one gets older.²

Geriatric depression has also been associated with cognitive impairment, and because it can manifest without the traditional hallmarks of “sadness,” it may lead to incorrect diagnoses of dementia.^1,3 Research estimates that up to 14% of elderly adults experiencing a depressive episode are admitted to a nursing home because of the severity of their condition, and cognitive impairment is documented in up to 94% of these cases.⁴ Researchers continue to evaluate different pathophysiological pathways and shared mechanisms between mood disorders and cognitive decline in order to more accurately diagnose and treat these conditions. Preliminary research in this area suggests that brain-derived neurotrophic factors from everyday exercise such as meditation and yoga may be protective against depression and cognitive decline.^4,5

IFM certified practitioner Jane Murray, MD, has incorporated a six-week mindfulness-based stress reduction program and yoga classes into her functional medicine practice in Kansas City. Mind-body practices like yoga and meditation may help to reduce stress and enhance overall well-being and cognitive function. A systematic review evaluating the health effects of yoga in elderly patients found several studies that reported a positive benefit of yoga on improving mood, executive function, and semantic memory.⁶

In the following video, Dr. Murray explains her unique approach to functional medicine, including how she plans to “rewire” her practice as she transitions into retirement.

In addition to yoga, older adults may also benefit from mindfulness-based stress reduction and cognitive therapy, according to a 2019 study published in Clinical Gerontology.⁵ Reduced cortical thickness in the brain is theorized to be one possible mechanism of cognitive decline and is a predictive risk factor for Alzheimer’s and other types of dementia.⁷ Mindfulness programs and art therapy have been shown to improve memory and overall cognitive memory function over time and were accompanied by marked increases in cortical thickness.^8-9 The positive changes included improvements in focus, divided attention, and short-term memory.⁸ Stress management programs and cognitive brain training may be important interventions for this population.

Another unique feature of Dr. Murray’s functional medicine practice is her use of Dr. Dale Bredesen’s protocol for Alzheimer’s disease. Approximately 5.7 million Americans are living with Alzheimer’s disease, and by 2050, this number is projected to rise to nearly 14 million.¹⁰ Dr. Bredesen’s protocol evaluates 150 different variables known to contribute to Alzheimer’s disease—including biochemistry, genetics, and historical imaging—to help clinicians develop a personalized patient treatment protocol.

Functional medicine gives clinicians the tools to improve patient outcomes through integrated care and the flexibility to reimagine their practice models to align with their career goals.

References

1. Devita M, De Salvo R, Ravelli A, et al. Recognizing depression in the elderly: practical guidance and challenges for clinical management. Neuropsychiatr Dis Treat. 2022;18:2867-2880. doi:10.2147/NDT.S347356
2. Sowan W, Rutin R, Cohen M. Chronic stressors, coping strategies, and depressive symptoms: a comparison across older age groups. Stress Health. Published online February 27, 2023. doi:10.1002/smi.3237
3. Brodaty H, Connors MH. Pseudodementia, pseudo-pseudodementia, and pseudodepression. Alzheimers Dement (Amst). 2020;12(1):e12027. doi:10.1002/dad2.12027
4. Sekhon S, Marwaha R. Depressive cognitive disorders. StatPearls Publishing. Updated May 8, 2023. https://www.ncbi.nlm.nih.gov/books/NBK559256/
5. Hazlett-Stevens H, Singer J, Chong A. Mindfulness-based stress reduction and mindfulness-based cognitive therapy with older adults: a qualitative review of randomized controlled outcome research. Clin Gerontol. 2019;42(4):347-358. doi:10.1080/07317115.2018.1518282
6. Karamacoska D, Tan T, Mathersul DC, et al. A systematic review of the health effects of yoga for people with mild cognitive impairment and dementia. BMC Geriatr. 2023;23(1):37. doi:10.1186/s12877-023-03732-5
7. Kim SJ, Jung NY, Kim YJ, et al. Clinical effects of frontal behavioral impairment: cortical thickness and cognitive decline in individuals with subjective cognitive decline and amnestic mild cognitive impairment. J Alzheimers Dis. 2019;69(1):213-225. doi:10.3233/JAD-190007
8. Yu J, Rawtaer I, Feng L, et al. Mindfulness intervention for mild cognitive impairment led to attention-related improvements and neuroplastic changes: results from a 9-month randomized control trial. J Psychiatr Res. 2021;135:203-211. doi:10.1016/j.jpsychires.2021.01.032
9. Yu J, Rawtaer I, Goh LG, et al. The art of remediating age-related cognitive decline: art therapy enhances cognition and increases cortical thickness in mild cognitive impairment. J Int Neuropsychol Soc. 2021;27(1):79-88. doi:10.1017/S1355617720000697
10.  Alzheimer’s Association. 2020 Alzheimer’s disease facts and figures. Alzheimers Dement. 2020;16(3):391-460. doi:10.1002/alz.12068