In its fifty-eighth session concluded on May 25, 2005, The World Health Assembly adopted a resolution and formed a new Commission on Social Determinants of Health on strengthening and promoting healthy aging. More than one billion people will be over 60 years old by 2025 - the vast majority in the developing world - and this figure is expected to double by 2050. The World Health Organization has projected that depression will soon be second only to heart disease as a cause of disability. In late-life, the average prevalence for all depressive disorders is about 16%. Older depressed persons often fail to acknowledge sad mood or loss of pleasure, which may greatly contribute to inadequate diagnosis and treatment. The inability to perceive themselves as sad while suffering cognitive and vegetative symptoms of depression is possibly due to neuroanatomical age-related changes. In this application, the candidate, supported by outstanding resources and mentorship, proposes in Specific Aim # 1 to study social perception tasks known to engage limbic functioning, and emotional awareness and psychosocial adaptation in nondysphoric late-life depression. Perception of facial expression will be used in Specific Aim #2, as a probe to examine the functioning of limbic and medial prefrontal structures using functional magnetic resonance methods. We expect an overall reduced functioning of the limbic and medial prefrontal structures in nondysphoric depression which will constitute the basis for improved identification of the disorder. This research and a training plan include superb mentoring in social and affective neuroscience, magnetic resonance imaging, geriatric psychiatry, and neuroanatomy. This will enable the candidate to expand his thematic clinical and investigational interest on emotion processing and achieve his career goals: to improve the neurobiological understanding and recognition of late-life nondysphoric depression, to set the stage for a productive independent research career on longitudinal effects of deficits in social cognition and emotion on the phenomenology of psychiatric disorders in late-life, and open the way toward psychological and somatic intervention research. Depression in late-life is a significant public health problem that increases the risk of death by medical conditions or suicide;about one-half of all depressed older individuals are not diagnosed despite seeking medical help, perhaps due to some older people having poor ability to recognize their own emotions, including sad mood. As a consequence many depressed older people show the disorder's classic features including poor self-esteem and hopelessness, without the crucial """"""""red flag"""""""" of low mood or loss of pleasure. The candidate and his multidisciplinary team of internationally recognized mentors seek to examine emotional awareness, perception of social stimuli, and the brain regions that are involved in these functions as indicators of older age depression-without-sadness, to uncover the brain bases for this debilitating psychiatric disorder, and improve its recognition and treatment.
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