Depressive Symptoms as a Predictor of Cognitive Decline: MacArthur Studies of Successful Aging

VA Greater Los Angeles Health System, HSR&D COE and GRECC, Los Angeles, CA 90073, USA.
American Journal of Geriatric Psychiatry (Impact Factor: 4.24). 05/2007; 15(5):406-15. DOI: 10.1097/01.JGP.0b013e31802c0c63
Source: PubMed


The prevalence of dementia continues to rise, and yet, there are few known modifiable risk factors. Depression, as a treatable condition, may be important in the development of dementia. Our objective was to examine the association between depressive symptoms and longitudinal cognitive changes in older adults who were high-functioning at baseline.
The authors analyzed data from a community-based cohort (aged 70-79 at baseline), who, at study entry, scored 7 or more (out of 9) on the Short Portable Mental Status Questionnaire (SPMSQ). Depressive symptoms were assessed at baseline using the depression subscale of the Hopkins Symptom Check List. Cognitive performance was measured at baseline and at seven-year follow up by the SPMSQ and by summary scores from standard tests of naming, construction, spatial recognition, abstraction, and delayed recall.
After adjusting for potential confounders, including age, education, and chronic health conditions such as diabetes, heart attack, stroke, and hypertension, a higher number of baseline depressive symptoms were strongly associated with greater seven-year decline in cognitive performance and with higher odds of incident cognitive impairment, i.e., decline in SPMSQ score to < or = 6 (adjusted odds ratio per quartile of depressive symptoms score: 1.34, 95% confidence interval: 1.10-1.68).
Depressive symptomatology independently predicts cognitive decline and incident cognitive impairment in previously high-functioning older persons.

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    • "Our results support previous researches that depression can predict subsequent cognitive decline [6] [10] [18] [19] [20] [21] [22], and are consistent with Raji et al. [13]'s finding in older Mexican Americans. Moreover, our findings confirm that there is a causal association from depression to cognitive decline in later life, which is similar to Bunce et al. [23]' report. "
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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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    • "Depressive symptoms and other distressful states have also been linked to significantly increased risk for diabetes, CVD, stroke, and the metabolic syndrome (57–59), and are a significant contributor to the profound reductions in quality of life reported by those with cognitive impairment (12, 31). Anxiety and depressive symptoms are also significant predictors of cognitive decline and incident cognitive impairment (60, 61). Moreover, in those with MCI, behavioral and psychological symptoms, including anxiety, depression, irritability, and apathy, are strong predictors of progression to AD (28, 62). "
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    ABSTRACT: Alzheimer's disease (AD) is a chronic, progressive, brain disorder that affects at least 5.3 million Americans at an estimated cost of $148 billion, figures that are expected to rise steeply in coming years. Despite decades of research, there is still no cure for AD, and effective therapies for preventing or slowing progression of cognitive decline in at-risk populations remain elusive. Although the etiology of AD remains uncertain, chronic stress, sleep deficits, and mood disturbance, conditions common in those with cognitive impairment, have been prospectively linked to the development and progression of both chronic illness and memory loss and are significant predictors of AD. Therapies such as meditation that specifically target these risk factors may thus hold promise for slowing and possibly preventing cognitive decline in those at risk. In this study, we briefly review the existing evidence regarding the potential utility of meditation as a therapeutic intervention for those with and at risk for AD, discuss possible mechanisms underlying the observed benefits of meditation, and outline directions for future research.
    Frontiers in Psychiatry 04/2014; 5:40. DOI:10.3389/fpsyt.2014.00040
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    • "Depression is common among older adults and has been associated with increased risk of cognitive decline [70,71]. Until recently, little was known about the relationship of depression to dementia among the oldest old. "
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    ABSTRACT: The population of oldest old, or people aged 85 and older, is growing rapidly. A better understanding of dementia in this population is thus of increasing national and global importance. In this review, we describe the major epidemiological studies, prevalence, clinical presentation, neuropathological and imaging features, risk factors, and treatment of dementia in the oldest old. Prevalence estimates for dementia among those aged 85+ ranges from 18 to 38%. The most common clinical syndromes are Alzheimer's dementia, vascular dementia, and mixed dementia from multiple etiologies. The rate of progression appears to be slower than in the younger old. Single neuropathological entities such as Alzheimer's dementia and Lewy body pathology appear to have declining relevance to cognitive decline, while mixed pathology with Alzheimer's disease, vascular disease (especially cortical microinfarcts), and hippocampal sclerosis appear to have increasing relevance. Neuroimaging data are sparse. Risk factors for dementia in the oldest old include a low level of education, poor mid-life general health, low level of physical activity, depression, and delirium, whereas apolipoprotein E genotype, late-life hypertension, hyperlipidemia, and elevated peripheral inflammatory markers appear to have less relevance. Treatment approaches require further study, but the oldest old may be more prone to negative side effects compared with younger patients and targeted therapies may be less efficacious since single pathologies are less frequent. We also highlight the limitations and challenges of research in this area, including the difficulty of defining functional decline, a necessary component for a dementia diagnosis, the lack of normative neuropsychological data, and other shortcomings inherent in existing diagnostic criteria. In summary, our understanding of dementia in the oldest old has advanced dramatically in recent years, but more research is needed, particularly among varied racial, ethnic, and socioeconomic groups, and with respect to biomarkers such as neuroimaging, modifiable risk factors, and therapy.
    Alzheimer's Research and Therapy 07/2013; 5(4):27. DOI:10.1186/alzrt181 · 3.98 Impact Factor
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