Depressive Symptoms and Cognitive Decline in Late Life

Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
Archives of General Psychiatry (Impact Factor: 14.48). 03/2006; 63(2):153-60. DOI: 10.1001/archpsyc.63.2.153
Source: PubMed


Depression is associated with cognitive impairment and dementia. It is less clear whether depression contributes to further cognitive decline over time, independently of incipient dementia.
To examine the relationship between depressive symptoms and subsequent cognitive decline in a cohort of nondemented older adults, some of whom remained dementia free during follow-up and others in whom incident dementia eventually developed.
Twelve-year prospective epidemiological study, including biennial measurement of cognition and depressive symptoms, biennial assessment of dementia, and comparison of cognitive function at baseline and over time in persons with and without baseline depressive symptoms in the dementia-free and eventual-dementia groups, using random-effects models.
A largely blue-collar rural community.
Population-based sample of 1265 adults 67 years and older without dementia at baseline.
Scores over time on each of several cognitive test composites.
Among 1094 participants who remained dementia free, those with baseline depressive symptoms had significantly lower baseline scores on all cognitive composites than the nondepressed participants. Among the 171 individuals in whom dementia later developed, depression was associated with worse performance in some but not all baseline cognitive composites. Cognitive decline over time was minimal in the dementia-free group, whereas marked decline was seen in the eventual-dementia group. Depressive symptoms were not associated with rate of cognitive decline over time in either group.
Depressive symptoms are cross-sectionally associated with cognitive impairment but not subsequent cognitive decline. Substantial cognitive decline over time cannot be explained by depression and most likely reflects incipient dementia.

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    • "However, memory (Biringer et al., 2005) and visual–spatial ability (Hart et al., 1987) have also been found to be impaired in other studies. Furthermore, some investigations suggest that LLD increases the risk for continued cognitive decline and subsequent dementia, even after symptoms remit (Green et al., 2003; Ownby et al., 2006; Lee et al., 2007), while in other studies, these associations were not found (Lindsay et al., 2002; Ganguli et al., 2006; Becker et al., 2009). The question as to why depression in late life can have a pervasive negative influence on cognition in some individuals but not all remains to be reconciled. "
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    ABSTRACT: Objective The present study aimed to investigate whether cognitive reserve moderated the association between depressive symptoms and cognition, as well as brain volumes in a sample of older adults.Methods Non-demented participants (n = 3484) were selected from the Washington Heights/Hamilton Heights Inwood Columbia Aging Project (Northern Manhattan). A subsample of these participants without dementia (n = 703), who had brain imaging data, was also selected for a separate analysis. Depressive symptomatology was assessed with the 10-item Center for Epidemiologic Studies Depression Scale. Reading level and years of education were used as measures of cognitive reserve. Four distinct cognitive composite scores were calculated: executive function, memory, visual–spatial, and language.ResultsMultiple regression analysis revealed interaction effects between both measures of cognitive reserve and depressive symptoms on all the cognitive outcome measures except for visual–spatial ability. Those with greater reserve showed greater cognitive decrements than those with lower levels of reserve as depressive symptoms increased. A borderline interaction effect was revealed between reading level and depressive symptoms on total brain volumes. Those with lower reading scores showed greater volume loss as depressive symptoms increased than those with higher reading scores.Conclusions Our findings indicate that the association between late-life depressive symptoms and core aspects of cognition varies depending on one's level of cognitive reserve. Those that had greater levels of education and/or reading ability showed a greater decrease in memory, executive, and language performances as depressive symptoms increased than those with lower years of education and reading ability. Copyright © 2014 John Wiley & Sons, Ltd.
    International Journal of Geriatric Psychiatry 08/2014; 30(6). DOI:10.1002/gps.4192 · 2.87 Impact Factor
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    • "Some studies have found that high scores on the CES-D are associated with an increased risk of developing dementia (Wilson et al. 2002 ; Gatz et al. 2005), but evidence that elevated levels of depressive symptoms are predictive of cognitive decline in older people without dementia is inconsistent. Ganguli et al. (2006) studied over 1200 such individuals using the CES-D and composite scores from a battery of cognitive tests, all of which were administered biennially, and found no link between depressive symptoms and rate of cognitive decline over 12 years. In a study of 1600 people using the CES-D and a cruder measure of cognitive decline, decrease in MMSE score of o5 points over 3 years, Dufouil et al. (1996) found no association between depressive symptoms and risk of cognitive deterioration. "
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    Psychological Medicine 10/2012; 42(10):2057-69. DOI:10.1017/S0033291712000402 · 5.94 Impact Factor
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    • "The prevalence of dementia syndromes, particularly Alzheimer's disease, is substantial (Hendrie, 1998) and increasing with demographic aging (Evans, 1990). Cognitive dysfunction is also a central feature of many types of medical and major psychiatric disorder (Weiland- Fiedler et al., 2004; Bowie and Harvey, 2005; Ganguli et al., 2006) and is associated with impaired adaptive function (Harvey et al., 1997), diminished capacity to participate in medical decision making (Katz et al., 1995), and increased risk of adverse treatment outcomes (Breier et al., 1991). "
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    ABSTRACT: Effective screening of cognitive disorders is limited by psychometric and practical properties of available instruments. The Brief Cognitive Screen (BCS) was developed to improve sensitivity and overall diagnostic accuracy of case detection for cognitive dysfunction in a quick and convenient format. This validation study compared psychometric properties of the BCS with the Mini mental state examination (MMSE) in 308 patients with suspected or known disorders of cognition. Diagnostic accuracy of the MMSE was determined using the traditional 23/24 clinical cutoff and area under the curve (AUC) from receiver operating characteristics (ROC) analyses. Diagnostic accuracy of BCS summary scores and components was determined by ROC analyses. Comprehensive neuropsychological evaluation served as the criterion standard for determining cognitive dysfunction. The MMSE sensitivity (34.8%) was inadequate at the 23/24 cutoff. Under ROC analyses, diagnostic accuracy of a BCS summary score was superior (AUC = 0.950) to the MMSE total score (AUC = 0.862) for the total sample. Excluding all patients with a history of cognitive deficit, classification accuracy of the BCS remained high (AUC = 0.936). Findings suggest that BCS is an effective, convenient alternative screening instrument for use in clinical populations with suspected cognitive dysfunction.
    International Journal of Geriatric Psychiatry 09/2012; 27(9):914-23. DOI:10.1002/gps.2802 · 2.87 Impact Factor
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