Fear acquisition and extinction in elderly patients with depression

Christina Rainer; Sarah Nasrouei; Simon Tschofen; Harald R Bliem; Frank H Wilhelm; Josef Marksteiner

doi:10.1016/j.jad.2020.06.044

Fear acquisition and extinction in elderly patients with depression

J Affect Disord. 2020 Nov 1:276:197-204. doi: 10.1016/j.jad.2020.06.044. Epub 2020 Jul 13.

Authors

Christina Rainer¹, Sarah Nasrouei², Simon Tschofen³, Harald R Bliem⁴, Frank H Wilhelm⁵, Josef Marksteiner³

Affiliations

¹ Department of Psychiatry and Psychotherapy A, State Hospital Hall, Hall, Austria; Department of Psychology, University of Innsbruck, Innsbruck, Austria. Electronic address: christina.rainer@tirol-kliniken.at.
² Department of Psychiatry and Psychotherapy A, State Hospital Hall, Hall, Austria; Division of Clinical Psychology, Psychotherapy, and Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria.
³ Department of Psychiatry and Psychotherapy A, State Hospital Hall, Hall, Austria.
⁴ Department of Psychology, University of Innsbruck, Innsbruck, Austria.
⁵ Division of Clinical Psychology, Psychotherapy, and Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria.

PMID: 32697699
DOI: 10.1016/j.jad.2020.06.044

Abstract

Background: Depression in elderly patients is common and characterized by anxiety symptoms and cognitive impairment. To our knowledge, no studies have yet investigated the process of fear extinction in these patients. We investigated fear extinction with a paradigm consisting of habituation, acquisition and extinction.

Methods: We included three age matched (mean age: 75.7 years) groups: Late Life Depression (LLD, n = 33), Mild Cognitive Impairment (MCI, n = 39), healthy controls (HC, n = 39). All participants were diagnosed with a standardized procedure including clinical examination, CERAD cognitive test battery, as well as magnetic resonance imaging. Participants underwent a fear conditioning paradigm consisting of habituation, acquisition, and extinction. During acquisition, a neutral face (conditioned stimulus, CS+) was paired with an electrical unconditioned stimulus, whereas another face (safety stimulus, CS-) was unpaired. Conditioned responses were measured by US-expectancy and valence ratings.

Results: Compared to HC, both patient groups showed a significantly lower, differential (CS+ vs. CS-) fear acquisition across all measurements. Patients with cognitive impairment showed a significantly slower extinction, which is characterized by higher US-expectancy and reduced positive valence for CS+. Fear extinction was significantly less differential (CS+ vs. CS-) in patients with LLD.

Limitations: Due to the cross-sectional design we cannot distinguish whether the observed differences in fear extinction are state or trait markers in the LLD patients.

Conclusions: In this study, we demonstrate that fear extinction is impaired in elderly patients with depression. These results can have influence on treatment strategies.

Keywords: Amygdala; Emotional learning; Fear conditioning; Late life depression; Memory.

MeSH terms

Aged
Conditioning, Classical
Cross-Sectional Studies
Depression*
Extinction, Psychological*
Fear
Humans