Article

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

ABSTRACT

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.

Download full-text

Full-text

Available from: Hiroko Hayama Dodge
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    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
  • Source
    • "The relationship between depression and concurrent cognitive function is now indisputable. Most studies have found depressive symptoms or disorders to be associated with poor cognitive test performance (Nebes et al., 2000; Sheline et al., 2006; Butters et al., 2004; Bhalla et al., 2006; Ganguli et al., 2006). Depression should be actively recognized and appropriately treated because it is a significant source of morbidity and mortality in its own right. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Mild cognitive impairment (MCI) is associated with early memory loss, Alzheimer's disease (AD) neuropathology, inefficient or ineffective neural processing, and increased risk for AD. Unfortunately, treatments aimed at improving clinical symptoms or markers of brain function generally have been of limited value. Physical exercise is often recommended for people diagnosed with MCI, primarily because of its widely reported cognitive benefits in healthy older adults. However, it is unknown if exercise actually benefits brain function during memory retrieval in MCI. Here, we examined the effects of exercise training on semantic memory activation during functional magnetic resonance imaging (fMRI). Seventeen MCI participants and 18 cognitively intact controls, similar in gender, age, education, genetic risk, and medication use, volunteered for a 12-week exercise intervention consisting of supervised treadmill walking at a moderate intensity. Both MCI and control participants significantly increased their cardiorespiratory fitness by approximately 10% on a treadmill exercise test. Before and after the exercise intervention, participants completed an fMRI famous name discrimination task and a neuropsychological battery, Performance on Trial 1 of a list-learning task significantly improved in the MCI participants. Eleven brain regions activated during the semantic memory task showed a significant decrease in activation intensity following the intervention that was similar between groups (p-values ranged 0.048 to 0.0001). These findings suggest exercise may improve neural efficiency during semantic memory retrieval in MCI and cognitively intact older adults, and may lead to improvement in cognitive function. Clinical trials are needed to determine if exercise is effective to delay conversion to AD.
    Full-text · Article · Jun 2013 · Journal of Alzheimer's disease: JAD
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Cross-sectional surveys of older people commonly find associations between higher levels of depressive symptoms and poorer cognitive performance, but the direction of effect is unclear. We examined whether there was a bidirectional relationship between depressive symptoms and general cognitive ability in non-demented older people, and explored the role of physical health, smoking, exercise, social class and education as potential confounders of this association and as possible determinants of the rate of change of cognitive decline and depressive symptoms. Method The English Longitudinal Study of Ageing consists of people aged 50 years and over. Cognitive function and self-reported depressive symptoms were measured in 2002-2003, 2004-2005, 2006-2007 and 2008-2009. We fitted linear piecewise models with fixed knot positions to allow different slopes for different age groups. Analyses are based on 8611 people. Mean cognitive function declined with age; there was no trend in the trajectory of depressive symptoms. Better cognitive function was associated with less depression up to the age of 80 years. Greater depression was associated with a slightly faster rate of cognitive decline but only in people aged 60-80 years. There were no consistent associations across age groups between sex, smoking, education, social class, exercise or number of chronic physical illnesses and the rate of change of cognitive decline or depressive symptoms. In this longitudinal study of older people, there was no consistent evidence that being more depressed led to an acceleration in cognitive decline and no support for the hypothesis that there might be reciprocal dynamic influences between cognitive ability and depressive symptoms.
    Full-text · Article · Oct 2012 · Psychological Medicine
Show more