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 have been observed to be associated with cognitive decline for cohort dementia-free elderly. More severe baseline depressive symptoms were strongly correlated with greater cognitive decline and higher risk of cognitive impairment seven years later (Chodosh et al., 2007). Similarly, average, increased, and concurrent depressive symptoms were associated with cognitive decline in USA (Dotson et al., 2008) and in Europe (Köhler et al., 2010). "
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    ABSTRACT: This study investigates the role of gender in the associations of long-term depressive symptoms and leisure-time physical activity (LTPA) with the risk of cognitive decline in elderly Taiwanese. We analyzed 3,679 subjects (age ≥57) in the 2003 and 2007 datasets of the Taiwan Longitudinal Survey on Aging, of which data were collected via face-to-face interviews by trained interviewers. We excluded proxy respondents. Multivariable logistic regression analysis examined the associations of long-term depressive symptoms (increased symptoms: CES-D10 scores from <10 to ≥10; decreased symptoms: from ≥10 to<10) and LTPA (frequency, duration, and intensity) with cognitive decline (a decrease of two or more SPMSQ scores). Women had significant higher percentages of cognitive impairment, compared to men, at the baseline (5.9 vs. 1.5%; χ(2)=51.24, p<0.001) and end-point (10.8 vs. 5.2%;χ(2)=39.5, p<0.001). Men with long-term depressive symptoms had 5.28 greater odds of cognitive decline (OR=5.28, 95%CI=2.84-9.82, p<0.001) and men with increased depressive symptoms had 2.09 greater odds (2.09, 1.24-3.51, p=0.006). No such association was observed in women. Men with consistently high LTPA had 65% (0.35, 0.19-0.65, p=0.001) and women with increased LTPA had 43% (0.57, 0.34-0.93, p=0.024) reduction in odds of developing cognitive decline. We found gender differences in the longitudinal association between depressive symptoms and cognitive decline. Long-term LTPA may loosen the association between long-term depressive symptoms and cognitive decline. These findings are useful in the identification of vulnerable elderly in the Taiwanese population and public health interventions should focus on assisting their cognitive aging. Copyright © 2015. Published by Elsevier Inc.
    Preventive Medicine 05/2015; 77. DOI:10.1016/j.ypmed.2015.05.001 · 3.09 Impact Factor
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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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