Stress speeds mental decline in impaired elders

Chronic stress can speed up memory decline in older people who already have some impairment in their mental function, a new study in the American Journal of Psychiatry shows.

But being stressed doesn't appear to affect memory in older people without such impairment, Dr. Guerry M. Peavy of the University of California San Diego and colleagues found.

Research suggests a "strong relationship" between increased stress and memory loss, the researchers note, but few investigators have looked at stress and memory over time. Chronic stress may affect memory by causing prolonged release of so-called "stress hormones," such as cortisol, resulting in damage to the brain.

To investigate, the researchers followed 52 people 65 to 97 years old for up to three years. Twenty-five had no loss of mental function at the beginning of the study, while the remaining 27 showed evidence of mild mental impairment.

To measure stress, the researchers asked study participants about whether they had experienced stressful life events in the previous year or six months, such as being hospitalized or having a death in the family. A person was considered to have "high stress" if they reported at least one such event in a given period.

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Brain Stimulation: Electroconvulsive Therapy ECT, checkered past and all, is making a quiet comeback

Electroconvulsive therapy, also known from times of old as "shock therapy," is on the rise—albeit a relatively quiet one. Considering its beginnings as a crude and violent procedure, it's not surprising that ECT's comeback isn't loudly publicized. The treatment, which involves inducing a controlled seizure, is most often administered to patients with significant psychiatric illness—depression, mania, and bipolar disorder—and is one form of brain stimulation therapy for people whose symptoms don't respond to medications. Kitty Dukakis, actress and wife of 1988 presidential candidate Michael Dukakis, has spoken candidly in recent years about her reliance on the treatment, the only one that significantly alleviates her bouts with severe depression. Many clinical trials are currently investigating ECT to better understand why it seems to work against major depression—it puts 60 percent to 80 percent of people who try it into remission—and researchers at the National Institute of Mental Health are investigating the therapy's potential in treatment of schizophrenia that does not respond to common medications. Still, the treatment suffers stigmatization—in part due to its association with mental illness but also due to its checkered past since its inception in the late 1930s.

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Antidepressants aid electroconvulsive therapy in treating severe depression

Combining antidepressant drugs with electroconvulsive therapy (ECT) does a better job of reducing symptoms of severe depression and causes less memory loss than using ECT alone, according to a new study by researchers at Wake Forest University School of Medicine and colleagues.

This finding could alleviate one of the primary concerns about ECT – that it causes memory loss, said W. Vaughn McCall, M.D., M.S, professor and chairman of the Department of Psychiatry and Behavioral Medicine and the principal investigator for the study's Wake Forest Baptist site.

The full study appears in the current issue of the Archives of General Psychiatry, published today.

ECT uses an electrical stimulus to the brain to induce seizures. It is prescribed for patients with crisis-level severe depression – who are catatonic (people who are so slowed down that they stop moving, talking and eating) or suicidal – or for patients with major depression who have not responded to medication. Electrodes attached to the head deliver the stimulus and patients are anesthetized and receive muscle relaxants during the procedure.

Patients receiving ECT often experience some memory loss that usually improves within days of treatment.

Researchers wanted to find a way to increase the effectiveness of ECT while reducing the side effects of memory loss.

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