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      Persistent depressive symptoms and cognitive decline in older adults

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          Abstract

          Background

          Little is known about the effect of persistent depressive symptoms on the trajectory of cognitive decline.

          Aims

          We aimed to investigate the longitudinal association between the duration of depressive symptoms and subsequent cognitive decline over a 10-year follow-up period.

          Method

          The English Longitudinal Study of Ageing cohort is a prospective and nationally representative cohort of men and women living in England aged ≥50 years. We examined 7610 participants with two assessments of depressive symptoms at wave 1 (2002–2003) and wave 2 (2004–2005), cognitive data at wave 2 and at least one reassessment of cognitive function (wave 3 to wave 7, 2006–2007 to 2014–2015).

          Results

          The mean age of the 7610 participants was 65.2 ± 10.1 years, and 57.0% were women. Of these, 1157 (15.2%) participants had episodic depressive symptoms and 525 participants (6.9%) had persistent depressive symptoms. Compared with participants without depressive symptoms at wave 1 and wave 2, the multivariable-adjusted rates of global cognitive decline associated with episodic depressive symptoms and persistent depressive symptoms were faster by –0.065 points/year (95% CI –0.129 to –0.000) and –0.141 points/year (95% CI –0.236 to –0.046), respectively ( P for trend < 0.001). Similarly, memory, executive and orientation function also declined faster with increasing duration of depressive symptoms (all P for trend < 0.05).

          Conclusions

          Our results demonstrated that depressive symptoms were significantly associated with subsequent cognitive decline over a 10-year follow-up period. Cumulative exposure of long-term depressive symptoms in elderly individuals could predict accelerated subsequent cognitive decline in a dose-response pattern.

          Declaration of interest

          None.

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          Most cited references21

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          Baseline neuropsychiatric symptoms and the risk of incident mild cognitive impairment: a population-based study.

          The authors conducted a prospective cohort study to estimate the risk of incident mild cognitive impairment in cognitively normal elderly (aged ≥70 years) individuals with or without neuropsychiatric symptoms at baseline. The research was conducted in the setting of the population-based Mayo Clinic Study of Aging.
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            Depressive symptoms and risk of dementia: the Framingham Heart Study.

            Depression may be associated with an increased risk for dementia, although results from population-based samples have been inconsistent. We examined the association between depressive symptoms and incident dementia over a 17-year follow-up period. In 949 Framingham original cohort participants (63.6% women, mean age = 79), depressive symptoms were assessed at baseline (1990-1994) using the 60-point Center for Epidemiologic Studies Depression Scale (CES-D). A cutpoint of > or = 16 was used to define depression, which was present in 13.2% of the sample. Cox proportional hazards models adjusting for age, sex, education, homocysteine, and APOE epsilon4 examined the association between baseline depressive symptoms and the risk of dementia and Alzheimer disease (AD). During the 17-year follow-up period, 164 participants developed dementia; 136 of these cases were AD. A total of 21.6% of participants who were depressed at baseline developed dementia compared with 16.6% of those who were not depressed. Depressed participants (CES-D >/=16) had more than a 50% increased risk for dementia (hazard ratio [HR] 1.72, 95% confidence interval [CI] 1.04-2.84, p = 0.035) and AD (HR 1.76, 95% CI 1.03-3.01, p = 0.039). Results were similar when we included subjects taking antidepressant medications as depressed. For each 10-point increase on the CES-D, there was significant increase in the risk of dementia (HR 1.46, 95% CI 1.18-1.79, p < 0.001) and AD (HR 1.39, 95% CI 1.11-1.75, p = 0.005). Results were similar when we excluded persons with possible mild cognitive impairment. Depression is associated with an increased risk of dementia and AD in older men and women over 17 years of follow-up.
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              Is Open Access

              HbA 1c , diabetes and cognitive decline: the English Longitudinal Study of Ageing

              Aims/hypothesis The aim of the study was to evaluate longitudinal associations between HbA1c levels, diabetes status and subsequent cognitive decline over a 10 year follow-up period. Methods Data from wave 2 (2004–2005) to wave 7 (2014–2015) of the English Longitudinal Study of Ageing (ELSA) were analysed. Cognitive function was assessed at baseline (wave 2) and reassessed every 2 years at waves 3–7. Linear mixed models were used to evaluate longitudinal associations. Results The study comprised 5189 participants (55.1% women, mean age 65.6 ± 9.4 years) with baseline HbA1c levels ranging from 15.9 to 126.3 mmol/mol (3.6–13.7%). The mean follow-up duration was 8.1 ± 2.8 years and the mean number of cognitive assessments was 4.9 ± 1.5. A 1 mmol/mol increment in HbA1c was significantly associated with an increased rate of decline in global cognitive z scores (−0.0009 SD/year, 95% CI −0.0014, −0.0003), memory z scores (−0.0005 SD/year, 95% CI −0.0009, −0.0001) and executive function z scores (−0.0008 SD/year, 95% CI −0.0013, −0.0004) after adjustment for baseline age, sex, total cholesterol, HDL-cholesterol, triacylglycerol, high-sensitivity C-reactive protein, BMI, education, marital status, depressive symptoms, current smoking, alcohol consumption, hypertension, CHD, stroke, chronic lung disease and cancer. Compared with participants with normoglycaemia, the multivariable-adjusted rate of global cognitive decline associated with prediabetes and diabetes was increased by −0.012 SD/year (95% CI −0.022, −0.002) and −0.031 SD/year (95% CI −0.046, −0.015), respectively (p for trend <0.001). Similarly, memory, executive function and orientation z scores showed an increased rate of cognitive decline with diabetes. Conclusions/interpretation Significant longitudinal associations between HbA1c levels, diabetes status and long-term cognitive decline were observed in this study. Future studies are required to determine the effects of maintaining optimal glucose control on the rate of cognitive decline in people with diabetes. Electronic supplementary material The online version of this article (10.1007/s00125-017-4541-7) contains peer-reviewed but unedited supplementary material, which is available to authorised users.
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                Author and article information

                Journal
                The British Journal of Psychiatry
                Br J Psychiatry
                Royal College of Psychiatrists
                0007-1250
                1472-1465
                November 2018
                August 22 2018
                November 2018
                : 213
                : 5
                : 638-644
                Article
                10.1192/bjp.2018.155
                30132434
                9b6b4263-d203-4768-9b70-142e60407905
                © 2018

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