Does the risk of developing dementia increase with the number of episodes in patients with depressive disorder and in patients with bipolar disorder? J Neurol Neurosurg Psychiatry

Department of Psychiatry, Aarhus University, Aarhus, Central Jutland, Denmark
Journal of Neurology Neurosurgery & Psychiatry (Impact Factor: 6.81). 01/2005; 75(12):1662-6. DOI: 10.1136/jnnp.2003.031773
Source: PubMed


Several findings suggest that some patients with depressive or bipolar disorder may be at increased risk of developing dementia. The present study aimed to investigate whether the risk of developing dementia increases with the number of affective episodes in patients with depressive disorder and in patients with bipolar disorder.
This was a case register study including all hospital admissions with primary affective disorder in Denmark during 1970-99. The effect of the number of prior episodes leading to admission on the rate of readmission with a diagnosis of dementia following the first discharge after 1985 was estimated. A total of 18,726 patients with depressive disorder and 4248 patients with bipolar disorder were included in the study.
The rate of a diagnosis of dementia on readmission was significantly related to the number of prior affective episodes leading to admission. On average, the rate of dementia tended to increase 13% with every episode leading to admission for patients with depressive disorder and 6% with every episode leading to admission for patients with bipolar disorder, when adjusted for differences in age and sex.
On average, the risk of dementia seems to increase with the number of episodes in depressive and bipolar affective disorders.

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Available from: Per K Andersen, Feb 28, 2014
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    • "Increases in recurrent episodes associate with decreases or loss of treatment response [62]. Given that a 2-3% decrement in some cognitive measures is associated with each depressive episode, accumulating detrimental effects are likely to occur in recurrent depression, with increased frequency of depressive episodes enhancing the risk of Alzheimer's disease [70]. Consequently, recurrent depression associates with a number of structural brain changes, including volume reductions in the hippocampus and basal ganglia, as well as in the orbitofrontal and subgenual prefrontal cortices [71]. "
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    • "According to the World Health Organization, major depression is the leading cause of disability worldwide and a major contributor to the global burden of disease [1]. A very harmful aspect of recurrent depression, both from an individual and a socioeconomic perspective , is that the cumulative exposure to depression is associated with the development of cognitive dysfunction in the euthymic state [2] [3], and an increased risk for out-right dementia [4] [5]. The cognitive deterioration occuring with each depressive episode may render the individual more susceptible to new episodes [6] [7]. "
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    • "Interestingly, the risk for mild cognitive impairment (MCI) and dementia seems to be higher in bipolar patients (the same is true for MDD patients ) (Reischies and Neu 2000; Jorm 2001; Kessing and Nilsson 2003) and it continues to rise with the number of the disease? s past episodes (Kessing and Andersen 2004). Regarding the basis of cognitive functioning, evidence has been forthcoming in recent years of differences in brain structure between bipolar patients and healthy individuals, as well as changes over time in patients . "
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