Article

Depressive Symptoms and Cognitive Decline in Nondemented Elderly Women

Department of Psychiatry, University of California, San Francisco, San Francisco, California, United States
Archives of General Psychiatry (Impact Factor: 14.48). 05/1999; 56(5):425-30. 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.

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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). "

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    • "Most of previous studies [8] [9] [10] [11] [12] [13] concluded the association between MMSE and CES-D either based on cross-section survey or longitudinal studies. The results from our study by MSMs were quite similar to those by traditional regression from the previous studies [8] [9] [10] [11] [12] [13]. "
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    • "In contrast, AD status in our present study was predicted by co-morbid depression or psychosis upon admission to the hospital. While many previous studies found a positive relationship between elevated depressive symptoms and dementia, AD, or cognitive decline [37] [38] [39] [40], other studies failed to observe an association [38] [39] [40] [41] [42], while still others found relationships in subgroups with baseline cognitive impairment [43] or relatively more education [44]. In a recent study of 2,425 initially non-demented older adults, depressive symptoms were found to precede memory decline in late-life, but not vice versa [45]. "
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    ABSTRACT: In the inpatient setting, prevalence, predictors, and outcomes [mortality risk (MR), length of stay (LOS), and total charges (TC)] of Alzheimer's disease (AD) are largely unknown. We used data on older adults (60+ y) from the Nationwide Inpatient Sample (NIS) 2002-2012. AD prevalence was ∼3.12% in 2012 (total weighted discharges with AD±standard error: 474, 410±6,276). Co-morbidities prevailing more in AD inpatient admissions included depression (OR = 1.67, 95% CI: 1.63-1.71, p < 0.001), fluid/electrolyte disorders (OR = 1.25, 95% CI: 1.22-1.27, p < 0.001), weight loss (OR = 1.26, 95% CI: 1.22-1.30, p < 0.001), and psychosis (OR = 2.59, 95% CI: 2.47-2.71, p < 0.001), with mean total co-morbidities increasing over time. AD was linked to higherMRand longer LOS, but lower TC. TC rose in AD, while MR and LOS dropped markedly over time. In AD, co-morbidities predicting simultaneously higher MR, TC, and LOS (2012) included congestive heart failure, chronic pulmonary disease, coagulopathy, fluid/electrolyte disorders, metastatic cancer, paralysis, pulmonary circulatory disorders, and weight loss. In sum, co-morbidities and TC increased over time in AD, whileMRand LOS dropped. Fewco-morbidities predicted occurrence of AD or adverse outcomes in AD.
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