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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    • "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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    • "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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    ABSTRACT: In the inpatient setting, prevalence, predictors, and outcomes [mortality risk (MR), length of stay (LOS), and total charges (TC)] of Alzheimer's disease (AD) are largely unknown. We used data on older adults (60+ y) from the Nationwide Inpatient Sample (NIS) 2002-2012. AD prevalence was ∼3.12% in 2012 (total weighted discharges with AD±standard error: 474, 410±6,276). Co-morbidities prevailing more in AD inpatient admissions included depression (OR = 1.67, 95% CI: 1.63-1.71, p < 0.001), fluid/electrolyte disorders (OR = 1.25, 95% CI: 1.22-1.27, p < 0.001), weight loss (OR = 1.26, 95% CI: 1.22-1.30, p < 0.001), and psychosis (OR = 2.59, 95% CI: 2.47-2.71, p < 0.001), with mean total co-morbidities increasing over time. AD was linked to higherMRand longer LOS, but lower TC. TC rose in AD, while MR and LOS dropped markedly over time. In AD, co-morbidities predicting simultaneously higher MR, TC, and LOS (2012) included congestive heart failure, chronic pulmonary disease, coagulopathy, fluid/electrolyte disorders, metastatic cancer, paralysis, pulmonary circulatory disorders, and weight loss. In sum, co-morbidities and TC increased over time in AD, whileMRand LOS dropped. Fewco-morbidities predicted occurrence of AD or adverse outcomes in AD.
    • "adults nationwide (Adams et al., 2010). Depression is correlated with worse cognitive function in older adults (Christensen et al., 1997; Lyketsos et al., 2002), and studies have found that mild depressive symptoms are associated with an increased risk of developing mild cognitive impairment (Cabeza et al., 2002; Barnes et al., 2006), cognitive decline and dementia (Yaffe et al., 1999; Wilson et al., 2002). Although anti-depressant medications and psychotherapeutic interventions can effectively treat depression in most adults, efficacy is less well established in the elderly, particularly those with cognitive impairment or dementia (Bains et al., 2002; Mottram et al., 2006; Wilson et al., 2008). "
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    ABSTRACT: Depressive symptoms are common in older adults and associated with increased risk of cognitive impairment. Leisure activities are often promoted for individuals with mood symptoms but few studies compare the effects of different types of leisure activities on reducing depressive symptoms. Data were analyzed from participants enrolled from 2008-2009 in the Mental Activity and eXercise (MAX) Trial, which examined the effects of physical plus mental activity over 12 weeks in inactive older adults with cognitive complaints. There were no significant differences between intervention groups on the primary outcome of cognitive function or the secondary outcome of depressive symptoms; therefore, all participants were combined for the current analyses in which we examined changes in leisure activity engagement (Community Healthy Activities Model Program for Seniors (CHAMPS)), and changes in depressive symptoms (Geriatric Depression Scale (GDS)) as a function of changes in leisure activity engagement from baseline to post-intervention. Participants' mean age was 73.0 years, 61.6% were female, and 63.6% were non-Hispanic white. There was a significant change in total hours per week engaged in leisure activities from baseline (36.7 hours, SD = 12.7) to post-intervention (40.4 hours, SD = 15.7; paired t-test p = 0.02), and mean change in depressive symptoms was significantly inversely correlated with change in leisure activity hours such that increases in total leisure activity were associated with decreases in depressive symptoms (r = -0.21, p = 0.04). Increasing the total amount of leisure activity levels may help lower depressive symptoms in inactive older adults with cognitive complaints.
    International Psychogeriatrics 08/2015; DOI:10.1017/S1041610215001246 · 1.93 Impact Factor
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