Midlife vs Late-Life Depressive Symptoms and Risk of Dementia Differential Effects for Alzheimer Disease and Vascular Dementia Depressive Symptoms and Risk of Dementia

Barnes DE, Yaffe K, Byers AL, et al. — Tue, 01 May 2012 00:00:00 GMT

Context

Depression and dementia are common in older adults and often co-occur, but it is unclear whether depression is an etiologic risk factor for dementia.

Objective

To clarify the timing and nature of the association between depression and dementia.

Design

We examined depressive symptoms assessed in midlife (1964-1973) and late life (1994-2000) and the risks of dementia, Alzheimer disease (AD), and vascular dementia (VaD) (2003-2009) in a retrospective cohort study. Depressive symptoms were categorized as none, midlife only, late life only, or both. Cox proportional hazards models (age as timescale) adjusted for demographics and medical comorbidities were used to examine depressive symptom category and risk of dementia, AD, or VaD.

Setting

Kaiser Permanente Medical Care Program of Northern California.

Participants

Thirteen thousand five hundred thirty-five long-term Kaiser Permanente members.

Main Outcome Measure

Any medical record diagnosis of dementia or neurology clinic diagnosis of AD or VaD.

Results

Subjects had a mean (SD) age of 81.1 (4.5) years in 2003, 57.9% were women, and 24.2% were nonwhite. Depressive symptoms were present in 14.1% of subjects in midlife only, 9.2% in late life only, and 4.2% in both. During 6 years of follow-up, 22.5% were diagnosed with dementia (5.5% with AD and 2.3% with VaD). The adjusted hazard of dementia was increased by approximately 20% for midlife depressive symptoms only (hazard ratio, 1.19 [95% CI, 1.07-1.32]), 70% for late-life symptoms only (1.72 [1.54-1.92]), and 80% for both (1.77 [1.52-2.06]). When we examined AD and VaD separately, subjects with late-life depressive symptoms only had a 2-fold increase in AD risk (hazard ratio, 2.06 [95% CI, 1.67-2.55]), whereas subjects with midlife and late-life symptoms had more than a 3-fold increase in VaD risk (3.51 [2.44-5.05]).

Conclusions

Depressive symptoms in midlife or in late life are associated with an increased risk of developing dementia. Depression that begins in late life may be part of the AD prodrome, while recurrent depression may be etiologically associated with increased risk of VaD.

Association of Vascular Factors With Apathy in Community-Dwelling Elderly Individuals Vascular Factors and Apathy

Ligthart SA, Richard E, Fransen NL, et al. — Fri, 01 Jun 2012 00:00:00 GMT

Context

Apathy in community-dwelling elderly individuals has been associated with a history of stroke and other cardiovascular disease.

Objective

To assess the relationship between symptoms of apathy and cardiovascular risk factors or disease (stroke or other) in a large sample of elderly people aged 70 to 78 years without depression or dementia.

Design

Cross-sectional data analysis within an ongoing cluster-randomized, open, multicenter trial.

Setting

The Netherlands, general community.

Participants

We studied 3534 elderly individuals without dementia who were included in the Prevention of Dementia by Intensive Vascular Care trial.

Main Outcome Measures

Symptoms of apathy, assessed with 3 items from the 15-item Geriatric Depression Scale, in participants with few or no depressive symptoms.

Results

The median age of participants was 74.3 years. Principal components analysis of the Geriatric Depression Scale confirmed a separate factor for the apathy items (Geriatric Depression Scale–3A). Two or more symptoms of apathy were present in 699 participants (19.9%), of whom 372 (53.2%) were without depressive symptoms (Geriatric Depression Scale–12D score <2). Ordinal regression analysis showed that increasing apathy in the absence of depressive symptoms was associated with a history of stroke (odds ratio, 1.79; 95% CI, 1.38-2.31) and cardiovascular disease other than stroke (1.28; 1.09-1.52). Exploratory analysis among 1889 participants free from stroke and other cardiovascular disease revealed an association between apathy score and the following cardiovascular risk factors: systolic blood pressure (P = .03), body mass index (P = .002), type 2 diabetes mellitus (P = .07), and C-reactive protein (P < .001).

Conclusions

Symptoms indicative of apathy are common in community-dwelling nondemented older people who are free from depression. The independent association of stroke, other cardiovascular disease, and cardiovascular risk factors with symptoms of apathy suggests a causal role of vascular factors.

Trial Registration

isrctn.org Identifier: ISRCTN29711771

JAMA Psychiatry: Cerebrovascular Disease Topic Collection

Midlife vs Late-Life Depressive Symptoms and Risk of Dementia Differential Effects for Alzheimer Disease and Vascular Dementia Depressive Symptoms and Risk of Dementia

Association of Vascular Factors With Apathy in Community-Dwelling Elderly Individuals Vascular Factors and Apathy