Details
Category: Volume 07 Issue 04 April 2019
Hits: 379

Title: Relationship between High Sensitivity C-Reactive Protein Level and Depression in Elderly Patients

Authors: Salwa Mohamed Mahmoud, Mona Mohamed El-Mesky, Sekina Ismaeel Ahmed, Mona Wagdi Ayad, Ali Mahmoud Ramadan

 DOI: https://dx.doi.org/10.18535/jmscr/v7i4.196

Abstract

Background:  Depression is one of the highly prevalent disorders in elderly people and leads to an increased risk of mortality. Depressive illness is projected to be the second leading cause of disease burden after ischemic heart disease. Inflammation and depressive symptoms seem to be associated in large epidemiological cross-sectional studies. Among a lot of inflammatory markers, high-sensitivity C reactive protein (hs-CRP) is a specific inflammatory marker.

Objective: This study aimed to investigate the possible association between the serum level of high-sensitivity C reactive protein (hs-CRP) and depressive symptoms in the geriatric population.

Material and Methods: The study was carried out on 100 subjects (from both sexes (male and female) aged 60 years or older) divided into Group I (Control): including 50 subjects healthy volunteers, Group II (Depressed patients): including 50 patients who must fulfill a score of 5 or more over 15 of the Geriatric Depression Scale-short Form (GDS-15) and a score of 10 or more over 27 of the Patient Health Questionnaire (PHQ-9).

Results: hs-CRP levels in group II (cases) ranged from 0.67 – to 7.0. with a mean value (S.D) of 2.44 ± 1.91. hs-CRP among group I (control) ranged from 0.34 – 0.99 with a mean value (S. D) of 0.66 ± 0.18. hs-CRP was insignificantly higher among the cases group (p <0.001)

Conclusion: There was a statistically significant difference between the serum levels of hs-CRP in group II (cases) and group I (control).

Keywords: Depression; Inflammation; High-sensitivity C reactive protein (hs-CRP). 

References

  1. World Health Organization (WHO). The mental health of older adults. Geneva, Switzerland: WHO; 2017.
  1. Song BM, Lee JM, Choi W, Youm Y, Chu SH, Park YR, et al. Association between C reactive protein level and depressive symptoms in an elderly Korean population: Korean Social Life, Health, and Aging Project. BMJ Open 2015;5(2): e006429
  2. Xekardaki A, Santos M, Hof P, Kövari E, Bouras C, Giannakopoulos P. Neuropathological substrates, and structural changes in late-life depression: the impact of vascular burden. Acta Neuropathol 2012;124(4):453-64.
  3. Mezuk B, Eaton WW, Albrecht S, Golden SH. Depression, and type 2 diabetes over the lifespan: a meta-analysis. Diabetes Care. 2008;31(12):2383-90.
  4. Nicholson A, Kuper H, Hemingway H. Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies. Eur Heart J. 2006;27(23):2763-74.
  5. Liu Y, Li T, Zhang R, Guo L, Liu K. Poor Sleep Quality and Late-life Depression among The Elderly in Urban Communities in Liaoning, China: A Moderated Mediation Analysis. Arch gerontology and geriatric. 2018; 79:158-163.
  6. Aziz R, Steffens DC. What are the causes of late-life depression? Psychiatr Clin 2013;36(4):497-516.
  7. Anisman H, Merali Z. Cytokines, stress, and depressive illness: brain‐immune interactions. Ann Med 2003;35 (1):2-11.
  8. Franceschi C, Bonafe M, Valensin S, Olivieri F, De Luca M, Ottaviani E, et al. Inflamm-aging. An evolutionary perspective on immunosenescence. Ann N Y Acad Sci 2000;908:244-54.
  9. Giunta B, Fernandez F, Nikolic WV, Obregon D, Rrapo E, Town T, et al. Inflammaging as a prodrome to Alzheimer's disease. J Neuroinflammation 2008;5:51.
  10. Zalli A, Jovanova O, Hoogendijk WJ, Tiemeier H, Carvalho LA. Low-grade inflammation predicts the persistence of depressive symptoms. Psychopharmacol 2016;233(9): 1669-78.
  11. Faugere M, Micoulaud-Franchi JA, Faget-Agius C, Lançon C, Cermolacce M, Richieri R. High C-reactive protein levels are associated with depressive symptoms in schizophrenia. J Affect Disord 2018;225: 671-5.
  12. Wysokiński A, Socha K, Sołtysik BK, Kłoszewska I, Sobów T, Kostka T. Levels of C-reactive protein (CRP) in elderly patients with unipolar depression – case control analysis. Nord J Psychiatry 2016;70(7):503-7.
  13. Bowman BH. Hepatic plasma proteins: mechanisms of function and regulation. Elsevier; 2014; 2:62-6.
  14. Raison CL, Rutherford RE, Woolwine BJ, Shuo C, Schettler P, Drake DF, et al. A randomized controlled trial of the tumor necrosis factor antagonist infliximab for treatment-resistant depression: the role of baseline inflammatory biomarkers. JAMA Psychiatry 2013;70(1):31-41.
  15. Alavi NM, Khademalhoseini S, Vakili Z, Assarian F. Effect of Vitamin D Supplementation on Depression in Elderly Patients: A Randomized Clinical Trial. Clinical Nutrition. 2018 Sep 19;1-6.
  16. Chaaya M, Sibai AM, El Roueiheb Z, Chemaitelly H, Chahine LM, Al-Amin H, et al. Validation of the Arabic version of the short Geriatric Depression Scale (GDS-15). Int Psychogeriatr 2008;20(3):571-81.
  17. Shafiee M, Tayefi M, Hassanian SM, Ghaneifar Z, Parizadeh MR, Avan A, Rahmani F, Khorasanchi Z, Azarpajouh MR, Safarian H, Moohebati M. Depression and anxiety symptoms are associated with white blood cell count and red cell distribution width: A sex-stratified analysis in a population-based study. Psychoneuroendocrinology. 2017; 84:101-8.
  18. Pocinho MT, Farate C, Dias CA, Lee TT, Yesavage JA. Clinical and psychometric validation of the geriatric depression scale (GDS) for portuguese elders. Clinical Gerontologist. 2009;32(2):223-36.
  19. Kroenke K, Spitzer RL. The PHQ-9: a new depression diagnostic and severity measure. Psychiatric annals. 2002;32(9):509-15.
  20. Vargas HO, Nunes SO, de Castro MR, Vargas MM, Barbosa DS, Bortolasci CC, Venugopal K, Dodd S, Berk M. Oxidative stress, and inflammatory markers are associated with depression and nicotine dependence. Neurosci Lett 2013; 544:136-40.
  21. Au B, Smith KJ, Gariépy G, Schmitz N. The longitudinal associations between C‐reactive protein and depressive symptoms: evidence from the English Longitudinal Study of Ageing (ELSA). Int J Geriatr Psychiatry 2015;30(9):976-84.
  22. Johnston DE. Special considerations in interpreting liver function tests. Am Fam Physician 1999;59(8): 2223–30
  23. Shivaraj, Gowda; Prakash, B Desai; Vinayak, V Hull; Avinash, AK Math; Sonal N, Venekar; Shruthi S, Kulkarni. A review on laboratory liver function tests. The Pan African Medical Journal 2009; 3:17.
  24. Taylor, E. Howard. Clinical Chemistry. New York: John Wiley and Sons. 1989; pp. 4, 58–62.
  25. Semenkovich K, Brown ME, Svrakic DM, Lustman PJ. Depression in type 2 diabetes mellitus: prevalence, impact, and treatment. Drugs 2015;75(6):577-87.
  26. Bray, Christopher. Erythrocyte Sedimentation Rate and C-reactive Protein Measurements and Their Relevance in Clinical Medicine. 2016;115: 317–21
  27. Adriaensen W, Mathei C, van Pottelbergh G, Vaes B, Legrand D, Wallemacq P, et al. Significance of serum immune markers in identification of global functional impairment in the oldest old: cross-sectional results from the BELFRAIL study. Age (Dordr) 2014;36(1): 457-67.
  28. Fiske A, Wetherell JL, Gatz M. Depression in older adults. Annu Rev Clin Psychol 2009; 5:363-89
  29. Baune BT, Smith E, Reppermund S, Air T, Samaras K, Lux O, et al. Inflammatory biomarkers predict depressive, but not anxiety symptoms during aging: the prospective Sydney Memory and Aging Study. Psychoneuroendocrinology 2012;37(9):1521-30.
  30. Penninx BW, Kritchevsky SB, Yaffe K, Newman AB, Simonsick EM, Rubin S, et al. Inflammatory markers and depressed mood in older persons: results from the Health, Aging, and Body Composition study. Biol Psychiatry 2003;54(5):566-72.
  31. Kop WJ, Gottdiener JS, Tangen CM, Fried LP, McBurnie MA, Walston J, et al. Inflammation and coagulation factors in persons > 65 years of age with symptoms of depression but without evidence of myocardial ischemia. Am J Cardiol 2002;89(4):419-24.
  32. Zalli A, Jovanova O, Hoogendijk WJ, Tiemeier H, Carvalho LA. Low-grade inflammation predicts the persistence of depressive symptoms. Psychopharmacology (Berl) 2016;233(9):1669-78.
  33. Song BM, Lee JM, Choi W, Youm Y, Chu SH, Park YR, et al. Association between C reactive protein level and depressive symptoms in an elderly Korean population: Korean Social Life, Health and Aging Project. BMJ Open 2015;5(2): 006429.
  34. Grosse L, Carvalho LA, Wijkhuijs AJ, Bellingrath S, Ruland T, Ambree O, et al. Clinical characteristics of inflammation-associated depression: Monocyte gene expression is age-related in major depressive disorder. Brain Behav Immun 2015;44:48-56.
  35. Carvalho LA, Bergink V, Sumaski L, Wijkhuijs J, Hoogendijk WJ, Birkenhager TK, et al. Inflammatory activation is associated with a reduced glucocorticoid receptor alpha/beta expression ratio in monocytes of inpatients with melancholic major depressive disorder. Transl Psychiatry 2014;4:344.
  36. Carvalho LA, Juruena MF, Papadopoulos AS, Poon L, Kerwin R, Cleare AJ, et al. Clomipramine in vitro reduces glucocorticoid receptor function in healthy subjects but not in patients with major depression. Neuropsychopharmacology 2008;33(13):3182-9.
  37. Jones DR, Macias C, Barreira PJ, Fisher WH, Hargreaves WA, Harding CM. Prevalence, severity, and co-occurrence of chronic physical health problems of persons with serious mental illness. Psychiatr Serv 2004;55(11):1250-7.
  38. Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B. Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 2007;370(9590):851-8.
  39. Ford DE, Erlinger TP. Depression and C-reactive protein in US adults: data from the Third National Health and Nutrition Examination Survey. Arch Intern Med 2004;164(9):1010-4.
  40. Raison CL, Rutherford RE, Woolwine BJ, Shuo C, Schettler P, Drake DF, et al. A randomized controlled trial of the tumor necrosis factor antagonist infliximab for treatment-resistant depression: the role of baseline inflammatory biomarkers. JAMA Psychiatry 2013;70(1):31-41.
  41. van den Biggelaar AH, Gussekloo J, de Craen AJ, Frolich M, Stek ML, van der Mast RC, et al. Inflammation and interleukin-1 signaling network contribute to depressive symptoms but not cognitive decline in old age. Exp Gerontol 2007;42(7):693-701.
  42. Matsushima J, Kawashima T, Nabeta H, Imamura Y, Watanabe I, Mizoguchi Y, et al. Association of inflammatory biomarkers with depressive symptoms and cognitive decline in a community-dwelling healthy older sample: a 3-year follow-up study. J Affect Disord 2015;173:9-14.
  43. Kohler O, Krogh J, Mors O, Benros ME. Inflammation in Depression and the Potential for Anti-Inflammatory Treatment. Curr Neuropharmacol 2016;14(7):732-42.

Corresponding Author

Salwa Mohamed Mahmoud, MBBCh, Alex.

Resident, Ministry of Health Hospitals, Department of Internal Medicine, Faculty of Medicine, University of Alexandria, Alexandria, Egypt