Depressive Symptoms and Cognitive Decline in Nondemented Elderly Women

ArticleinArchives of General Psychiatry 56(5):425-30 · May 1999with11 Reads
Impact Factor: 14.48 · DOI: 10.1001/archpsyc.56.5.425 · Source: PubMed
Abstract

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.

    • "Our results endorsed previous findings that being female and having a mid-life SES disadvantage is related to more severe depressive symptomatology and a poorer cognitive status in old age. Some studies have shown that depressive symptomatology in a cohort is a precursor to cognitive decline [6, 8, 44, 47, 48]. However, our longitudinal analysis, that included five assessments of depressive symptomatology and general cognitive status using a cohort of older adult participants over 14 years, supports another set of studies showing an association between cognitive baseline status and depressive slope [3, 5, 7, 49]. "
    [Show abstract] [Hide abstract] ABSTRACT: Background Few longitudinal studies have analyzed how socioeconomic status (SES) influences both depressive and cognitive development over an individual’s life course. This study investigates the change trajectories of both depressive symptomatology and general cognitive status, as well as their associations over time, focusing on the effects of mid-life SES. Methods Data were obtained from the Taiwan Longitudinal Study on Aging (1993–2007), a nationally representative cohort study of older adults in Taiwan. The short form of the Center of Epidemiological Studies-Depression (CES-D) scale that measures depressive symptomatology in two domains (negative affect and lack of positive affect) was used. General cognitive status was assessed using the brief Short Portable Mental Status Questionnaire scale. Assessments of the subjects’ mid-life SES included measurement of the participant’s education and occupation. Analyses were conducted by the parallel latent growth curve modeling. Results The participants’ initial levels of depressive symptomatology and general cognitive status were significantly and negatively correlated; furthermore, any changes in these two outcomes were also correlated over time. The initial assessment of general cognitive status significantly contributed to any advancement towards more severe depressive symptomatology over time, particularly when this occurred in a negative manner. Furthermore, a mid-life SES advantage resulted in a significant reduction in late-life depressive symptomatology and also produced a slower decline in general cognitive status during later life. In contrast, lower mid-life SES exacerbated depressive symptomatology during old age, both at the initial assessment and in terms of the change over time. In addition, female gender was significantly associated with lower general cognitive status and more severe depressive symptomatology in negative affect. Conclusions These findings suggest a complex and longitudinal association between depressive symptomatology and general cognitive status in later life and this complicated relationship seems to be affected by mid-life SES over time.
    Full-text · Article · Dec 2016 · BMC Geriatrics
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    • "For example, the experience of a variety of health conditions has been linked to increases in older adults' depression (Lenze, Schulz, Martire, et al., 2005). Furthermore, depressed individuals may lose their motivation to overcome health-related problems, engage in health-compromising behaviors, or experience cognitive deficits and disturbances (Bruce, Seeman, Merrill, & Blazer, 2002; Yaffe, Blackwell, Gore, et al., 1999; Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008). Finally, the experience of emotional distress can cause a dysregulation of health-relevant physiological systems (e.g., hormonal and immune system, see Cohen, Janicki-Deverts, & Miller, 2007; Dantzer, O'Connor, Freund, Johnson, & Kelley, 2008; Folkman & Lazarus, 1986; Kiecolt-Glaser & Glaser, 1991).Figure 1 further shows that distress-related alterations in motivational, cognitive/ behavioral, and physiological processes can loop back, resulting in the development of new or more severe health problems (Fig. 1, paths c–a). "
    Full-text · Chapter · May 2016
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    • "For example, vascular risk factors are related to both dementia and depression [24]. Individuals with depression experience faster cognitive decline and high risk of dementia,25262728 and also have a greater risk of vascular and neurological outcomes [29, 30], myocardial infarction and coronary heart disease [31, 32], and stroke [33, 34]. In addition, a meta-analysis showed a reciprocal positive association between obesity and depression [35] while obesity is known as a risk factor for neurobiological diseases like stroke [36, 37]. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: The association between body mass index (BMI) and cognitive function is a public health issue. This study investigated the relationship between obesity and cognitive impairment which was assessed by the Korean version of the Mini-mental state examination (K-MMSE) among mid- and old-aged people in South Korea. Methods: A cohort of 5,125 adults, age 45 or older with normal cognitive function (K-MMSE≥24) at baseline (2006), was derived from the Korean Longitudinal Study of Aging (KLoSA) 2006∼2012. The association between baseline BMI and risk of cognitive impairment was assessed using multiple logistic regression models. We also assessed baseline BMI and change of cognitive function over the 6-year follow-up using multiple linear regressions. Results: During the follow-up, 358 cases of severe cognitive impairment were identified. Those with baseline BMI≥25 kg/m2 than normal-weight (18.5≤BMI<23 kg/m2) were marginally less likely to experience the development of severe cognitive impairment (adjusted odds ratio [aOR] = 0.73, 95% CI = 0.52 to 1.03; Ptrend = 0.03). This relationship was stronger among female (aOR = 0.63, 95%CI = 0.40 to 1.00; Ptrend = 0.01) and participants with low-normal K-MMSE score (MMSE: 24-26) at baseline (aOR = 0.59, 95% CI = 0.35 to 0.98; Ptrend<0.01). In addition, a slower decline of cognitive function was observed in obese individuals than those with normal weight, especially among women and those with low-normal K-MMSE score at baseline. Conclusion: In this nationally representative study, we found that obesity was associated with lower risk of cognitive decline among mid- and old-age population. Copyright © 2016 Kim et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
    Full-text · Article · Feb 2016 · PLoS ONE
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