Depressive Symptoms and Cognitive Decline in Nondemented Elderly Women

Department of Psychiatry, University of California-San Francisco School of Medicine, and the Veterans Affairs Medical Center, 94121, USA.
Archives of General Psychiatry (Impact Factor: 14.48). 05/1999; 56(5):425-30. DOI: 10.1001/archpsyc.56.5.425
Source: PubMed


The association between depressive disorders and subsequent cognitive decline is controversial. We tested the hypothesis that elderly women (aged 65 years and older) without dementia but with depressive symptoms have worse cognitive function and greater cognitive decline than women with few or no symptoms.
As part of an ongoing prospective study, we evaluated 5781 elderly, mostly white, community-dwelling women. Women completed the Geriatric Depression Scale short form. Three cognitive tests--Trails B, Digit Symbol, and a modified Mini-Mental State Examination--were administered at baseline and approximately 4 years later. Baseline, follow-up, and change scores for the cognitive tests were analyzed by analysis of covariance and Kruskal-Wallis analysis; the odds of cognitive deterioration (> or =3-point decline on the modified Mini-Mental State Examination) were determined by logistic regression.
At baseline, 211 (3.6%) of the women had 6 or more depressive symptoms. Only 16 (7.6%) of these women were receiving antidepressant medication. Increasing symptoms of depression were associated with worse performance at baseline and follow-up on all 3 tests of cognitive function (P<.001 for all comparisons). For example, the baseline Digit Symbol score (mean +/- SD) was 45.5 +/- 10.7 among women with 0 to 2 symptoms of depression, 40.3 +/- 10.7 for women with 3 to 5 symptoms, and 39.0 +/- 11.3 for women with 6 or more symptoms. After adjusting for the baseline score, cognitive change scores were also inversely associated with the number of depressive symptoms (P<.001 for all comparisons). Odds ratios for cognitive deterioration using 0 to 2 symptoms as the reference were 1.6 (95% confidence interval, 1.3-2.1) for 3 to 5 symptoms and 2.3 (95% confidence interval, 1.6-3.3) for 6 or more symptoms. Results were similar after being adjusted for education, age, health status, exercise, alcohol use, functional status, and clinic site.
Depressive symptoms in older women are associated with both poor cognitive function and subsequent cognitive decline. Mechanisms underlying the association between these 2 common conditions need further exploration.

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    • "In contrast, AD status in our present study was predicted by co-morbid depression or psychosis upon admission to the hospital. While many previous studies found a positive relationship between elevated depressive symptoms and dementia, AD, or cognitive decline [37] [38] [39] [40], other studies failed to observe an association [38] [39] [40] [41] [42], while still others found relationships in subgroups with baseline cognitive impairment [43] or relatively more education [44]. In a recent study of 2,425 initially non-demented older adults, depressive symptoms were found to precede memory decline in late-life, but not vice versa [45]. "
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    • "Most of previous studies [8] [9] [10] [11] [12] [13] concluded the association between MMSE and CES-D either based on cross-section survey or longitudinal studies. The results from our study by MSMs were quite similar to those by traditional regression from the previous studies [8] [9] [10] [11] [12] [13]. "
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    ABSTRACT: OBJECTIVE: the association between depressive symptoms (Center for Epidemiologic Studies Depression Scale [CES-D]) and subsequent cognitive function (Mini-Mental State Examination [MMSE]) is equivocal in literature. To examine the causal relationship between them, we use longitudinal data on MMSE and CESD and causal inference to illustrate the relationship between two health outcomes. METHOD: Data were obtained from the Hispanic Established Populations for Epidemiologic Studies of the Elderly. Participants included 3050 noninstitutionalized Mexican Americans aged 65 and older followed from 1993-2001. Cognitive function and depressive symptoms were assessed using the MMSE and CESD at baseline and at 2, 5, and 7 years of follow-up. Independent variables were sociodemographics, CESD, medical conditions. Marginal structural causal models were employed to evaluate the extent to which cognitive function depend not only on depressive symptoms measured at a single point in time but also on an individual's entire depressive symptoms history. DISCUSSION: our results indicate that if intervention to reduce 1 points of depressive symptoms were made at two years prior to assessing cognitive function, they would result in average improvement in cognitive function of 0.12, 95% CI [0.06, 0.18],P<.0001. Conclusion: The results suggest that depressive symptoms were significantly causally associated with cognitive impair.
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    • "Several observational studies have reported evidence that depression is a critical issue for those working with older adults, particularly for those working with older adults with Alzheimer's disease (AD) [5–7]. Depression affects numerous older adults [8] and has been associated with poor cognitive function [9]. Depression and dementia may be related in several aspects. "
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    ABSTRACT: Depression is a crucial public health problem because of its relatively high association with suicidal attempts, prolonged social isolation, poor physical health, and dementia. However, the available data and study on the prevalence of depression in Taiwan were mostly completed within the previous 1 to 2 decades, and these studies were limited to certain areas or populations. Little is known regarding the current status of depression in Taiwan. We used a brief tool, the Center for Epidemiological Studies Depression Scale (CES-D), to screen depression in 4 areas among the general and aged population. The results showed a higher CES-D score in the southern area among general (mean ± SD: 7.8 ± 8.4) or aged participants (mean ± SD: 7.2 ± 8.0) compared with other areas. The ratio of suspected depression patients was 16.4% of all recruited participants and 13.3% of aged participants. These results may provide information for this public health issue.
    07/2014; 2014(3):184018. DOI:10.1155/2014/184018
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