Depressed Mood is Not a Risk Factor for Incident Dementia in a Community-Based Cohort

Department of Psychiatry, School of Medicine, Graduate School of Public Health, University of Pittsburgh, 3501 Forbes Avenue, Pittsburgh, PA 15213, USA.
The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry (Impact Factor: 4.24). 09/2009; 17(8):653-63. DOI: 10.1097/JGP.0b013e3181aad1fe
Source: PubMed


To determine the relationship between depressed mood and the development of Alzheimer disease in cognitively normal individuals.
Longitudinal and observational.
Community-based cohort study.
A total of 288 participants in the Cardiovascular Health Study-Cognition Study (mean age: 77.52, SD =3.65, range: 70-89). All of the participants were adjudicated as cognitively normal in 1998/1999, and all had at least three visits before 1998/1999 with measures of cognition and mood state. The mean length of follow-up from 1998-1999 to 2007 was 7.1 years (range: 1-9 years, median =9 years).
The Center for Epidemiological Studies-Depression Scale (CESD) was used to index mood state, and the Modified Mini-Mental State Examination (3MSE) was the index of cognitive function among participants before 1998/1999. These measures were considered in two ways: participants were classified according to: 1) whether they showed a high-negative correlation between their CESD and 3MSE scores (i.e., indicating that greater depression was linked to poorer cognition) and 2) whether they showed persistently elevated CESD scores. The study outcome, development of dementia (N = 48), was based on consensus classifications, which was based on detailed neuropsychological and neurological exams.
The authors could find no consistent relationship between mood state, either alone or in relation to cognitive status, and the subsequent development of dementia. Those individuals whose cognitive functions were highly correlated with their mood state were no more likely to develop dementia than other participants. Those who had persistently depressed mood were also no more likely to develop dementia than those without persistently depressed mood.
Within the confines of this prospective, community-based study of elderly adults, the authors could not find strong evidence to support the hypothesis that mood disturbance was linked with the development of 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.
    Full-text · Article · Aug 2014 · International Journal of Geriatric Psychiatry
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    • "The present study failed to demonstrate an association between depression and incidence of dementia, in spite of the fact that most previous studies demonstrated an increased risk of dementia in old subjects who endorsed depressive symptoms [17, 23–25]. In fact, the previous negative studies had small sample size [2, 26] or were not population based but performed in specialized clinical setting [27]. In addition, the follow-up periods were usually larger in the positive studies [17, 25]. "
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    ABSTRACT: Objective. To analyze a potential cumulative effect of life-time depression on dementia and Alzheimer's disease (AD), with control of vascular factors (VFs). Methods. This study was a subanalysis of the Neurological Disorders in Central Spain (NEDICES) study. Past and present depression, VFs, dementia status, and dementia due to AD were documented at study inception. Dementia status was also documented after three years. Four groups were created according to baseline data: never depression (nD), past depression (pD), present depression (prD), and present and past depression (prpD). Logistic regression was used. Results. Data of 1,807 subjects were investigated at baseline (mean age 74.3, 59.3% women), and 1,376 (81.6%) subjects were evaluated after three years. The prevalence of dementia at baseline was 6.7%, and dementia incidence was 6.3%. An effect of depression was observed on dementia prevalence (OR [CI 95%] 1.84 [1.01-3.35] for prD and 2.73 [1.08-6.87] for prpD), and on dementia due to AD (OR 1.98 [0.98-3.99] for prD and OR 3.98 [1.48-10.71] for prpD) (fully adjusted models, nD as reference). Depression did not influence dementia incidence. Conclusions. Present depression and, particularly, present and past depression are associated with dementia at old age. Multiple mechanisms, including toxic effect of depression on hippocampal neurons, plausibly explain these associations.
    Full-text · Article · Sep 2013 · International Journal of Alzheimer's Disease
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    • "Study or subgroup Becker et al 11 (2009) Chen et al 12 (1999) Dal Forno et al 8 (2005), males Dal Forno et al 8 (2005), females Devanand et al 13 (1996) Fuhrer et al 14 (2003) Gatz et al 15 (2005) Geerlings et al 16 (2000) Geerlings et al 17 (2008) Irie et al 19 (2008) Kö hler et al 21 (2011) Lenoir et al 5 (2011) Li et al 23 (2011) Lindsay et al 24 (2002) Palmer et al 25 (2007) Saczynski et al 27 (2010) Total (95% CI) "
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    ABSTRACT: Background: Late-life depression may increase the risk of incident dementia, in particular of Alzheimer’s disease and vascular dementia. Aims: To conduct a systematic review and meta-analysis to evaluate the risk of incident all-cause dementia, Alzheimer’s disease and vascular dementia in individuals with late-life depression in population-based prospective studies. Method: A total of 23 studies were included in the meta-analysis. We used the generic inverse variance method with a random-effects model to calculate the pooled risk of dementia, Alzheimer’s disease and vascular dementia in older adults with late-life depression. Results: Late-life depression was associated with a significant risk of all-cause dementia (1.85, 95% CI 1.67-2.04, P<0.001), Alzheimer’s disease (1.65, 95% CI 1.42-1.92, P<0.001) and vascular dementia (2.52, 95% CI 1.77-3.59, P<0.001). Subgroup analysis, based on five studies, showed that the risk of vascular dementia was significantly higher than for Alzheimer’s disease (P = 0.03). Conclusions: Late-life depression is associated with an increased risk for all-cause dementia, vascular dementia and Alzheimer’s disease. The present results suggest that it will be valuable to design clinical trials to investigate the effect of late-life depression prevention on risk of dementia, in particular vascular dementia and Alzheimer’s disease.
    Full-text · Article · May 2013 · The British Journal of Psychiatry
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