Top

Published in:

01-03-2013 | Original Investigation

Depressive symptoms as predictor of dementia versus continuous cognitive decline: a 3-year prospective study

Authors: Andreas B. Neubauer, Hans-Werner Wahl, Horst Bickel

Published in: European Journal of Ageing | Issue 1/2013

Abstract

Previous research including meta-analytic efforts supports the assumption that depression is able to predict dementia. The mechanisms of this association still remain to be revealed. Some possible explanations as, for example, the glucocorticoid cascade hypothesis assumes that there are underlying changes at the cortical level that drive the association. Therefore, gradual levels of depressive symptoms may also predict gradual change (decline) in cognitive performance. However, testing both of these predictions (depressive symptoms lead to dementia, and depressive symptoms lead to cognitive decline, respectively) with the same data has to our knowledge not been done in the previous literature. A sample of 562 participants aged 65 or older was examined four times over a period of 3 years. Study participants completed established measures of depression and cognitive functioning. Results based on Cox regression analysis showed that depressive symptoms were not able to predict the conversion to dementia during the following 3 years. Additionally, structural equation models as well as latent change score models did not support the assumption that depressive symptoms predict cognitive decline, measured as a continuous variable. We discuss several possibilities to explain these findings including the potential and possible limits of the glucocorticoid cascade hypothesis.

In the year 1995 Germany introduced a statutory long-term care insurance. People who are persistently dependent on the assistance of caregivers are eligible for benefits from this insurance. These participants were excluded from this study as people in need for nursing are often diagnosed with dementia and have lower life expectancies. Because this study was planned as a longitudinal study to investigate the precursors of and risk factors for dementia (see Bickel et al. 2006), this exclusion criterion seemed justifiable.

We used CDR > .5 as cut-off because we did not expect many participants to develop moderate to severe dementia (CDR > 1) within this short measurement interval. Nevertheless, we repeated the analyses using a more strict criterion (classifying only participants with a CDR score of 2 or 3 as demented). The results obtained in this analysis did not change, the regression coefficient for the GDS score remained insignificant.

Please note that the regression weights of MMSE scores and GDS scores have already been fixed to be one in the configural invariance model.

Please note that this model was built under the assumption of strict factorial invariance for the latent depressive symptoms factor. Here, too, the level of factorial invariance across time was determined using the approach described above. Assessing factorial invariance for the cognition change factors was not appropriate given the different approach with which they were modeled. Therefore, factorial invariance was only determined for the latent depressive symptoms factor. The results of this analysis mirror the results for the SEM approach with one exception: the model under the assumption of strict factorial invariance did not fit significantly worse than the model under the assumption of strong factorial invariance, χ_diff ²(6) = 8.58, p = .199. Therefore, the model used for the LCM approach was tested under the assumption of strict factorial invariance for the latent depressive symptoms factor.

We thank an anonymous reviewer for this important observation.

Alexopoulos GS, Meyers BS, Young RC, Campbell S, Silbersweig D, Charlson M (1997) The ‘vascular depression’ hypothesis. Arch Gen Psychiatry 54(10):915–922CrossRef

American Psychiatric Association (1995) Diagnostic and statistical manual of mental disorders: DSM-IV, international version with ICD-10 codes, Washington, DC

Bassuk SS, Berkman LF, Wypij D (1998) Depressive symptomatology and incident cognitive decline in an elderly community sample. Arch Gen Psychiatry 55(12):1073–1081CrossRef

Becker JT, Chang Y-F, Lopez O, Dew MA, Sweet RA, Barnes D, Yaffe K, Young J, Kuller L, Reynolds CF III (2009) Depressed mood is not a risk factor for incident dementia in a community-based cohort. Am J Geriatr Psychiatry 17(8):653–663CrossRef

Bickel H, Mösch E, Seigerschmidt E, Siemen M, Förstl H (2006) Prevalence and persistence of mild cognitive impairment among elderly patients in general hospitals. Dement Geriatr Cogn Disord 7:242–250CrossRef

Binz U, Wendt G (1986) KUSTA. Kurz-Skala Stimmung/Aktivierung. Manual 2. Revidierte und erweiterte Auflage (Short scale mood/activation. Second edition). Beltz, Weinheim, Germany

Bremmer MA, Deeg DJH, Beekman ATF, Penninx BWJH, Lips P, Hoogendijk WJG (2007) Major depression in late life is associated with both hypo- and hypercortisolemia. Biol Psychiatry 62(5):479–486CrossRef

Brunner R, Schaefer D, Hess K, Parzer P, Resch F, Schwab S (2006) Effect of high-dose cortisol on memory functions. In: Yehuda R (ed) Psychobiology of posttraumatic stress disorders: a decade of progress. Blackwell Publishing, Malden, pp 434–437

Burke WJ, Rubin EH, Morris JC, Berg L (1988) Symptoms of “depression” in dementia of the Alzheimer type. Alz Dis Assoc Dis 2:356–362CrossRef

Byers AL, Yaffe K (2011) Depression and risk of developing dementia. Nat Rev Neurol 7:323–331CrossRef

Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383CrossRef

Chen P, Ganguli M, Mulsant BH, DeKosky ST (1999) The temporal relationship between depressive symptoms and dementia: a community-based prospective study. Arch Gen Psychiatry 56(3):261–266CrossRef

Comijs HC, Gerritsen L, Penninx BWJH, Bremmer MA, Deeg DJH, Geerlings MI (2010) The association between serum cortisol and cognitive decline in older persons. Am J Geriatr Psychiatry 18(1):42–50CrossRef

Cui X, Lyness JM, Tu X, King DA, Caine ED (2007) Does depression precede or follow executive dysfunction? Outcomes in older primary care patients. Am J Psychiatry 164(8):1221–1228CrossRef

De Nicola AF, Pietranera L, Beauquis J, Ferrini MG, Saravia FE (2009) Steroid protection in aging and age-associated diseases. Exp Gerontol 44:34–40CrossRef

Dimitrov DM (2010) Testing for factorial invariance in the context of construct validation. Meas Eval Couns Dev 43(2):121–149CrossRef

Dotson VM, Beydoun MA, Zonderman AB (2010) Recurrent depressive symptoms and the incidence of dementia and mild cognitive impairment. Neurology 75(1):27–34CrossRef

Dufouil C, Fuhrer R, Dartigues J-F, Alpérovitch A (1996) Longitudinal analysis of the association between depressive symptomatology and cognitive deterioration. Am J Epidemiol 144:634–641CrossRef

Erzigkeit H (2001) Kurztest zur Erfassung von Gedächtnis- und Aufmerksamkeitsstörungen: SKT; Form A; Form B; Form C; Form D; Form E. (Syndrom Short Test) Geromed, Erlangen, Germany

Folstein MF, Folstein SE, McHugh PR (1975) Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198CrossRef

Forsell Y, Winblad B (1998) Major depression in a population of demented and nondemented older people: prevalence and correlates. J Am Geriatr Soc 46(1):27–30

Gallagher P, Reid KS, Ferrier IN (2009) Neuropsychological functioning in health and mood disorder: modulation by glucocorticoids and their receptors. Psychoneuroendocrinology 34(Suppl 1):196–207CrossRef

Ganguli M, Du Y, Dodge HH, Ratcliff GG, Chang C-Ch (2006) Depressive symptoms and cognitive decline in late life. A prospective epidemiological study. Arch Gen Psychiatry 63(2):153–160

Geerlings MI, den Heijer T, Koudstaal PJ, Hofman A, Breteler MMB (2008) History of depression, depressive symptoms, and medial temporal lobe atrophy and the risk of Alzheimer disease. Neurology 70(15):1258–1264CrossRef

Henderson AS (1990) Co-occurence of affective and cognitive symptoms: the epidemiologial evidence. Dementia 1:119–123

Hughes C, Berg L, Danziger W, Coben L, Martin R (1982) A new clinical scale for the staging of dementia. Brit J Psychiatry 140(6):566–572CrossRef

Irie F, Masaki KH, Petrovitch H, Abbott RD, Ross GW, Taaffe DR, Launer LJ, White LR (2008) Apolipoporotein E ε4 allele genotype and the effect of depressive symptoms on the risk of dementia in men. The Honolulu-Asia Aging Study. Arch Gen Psychiatry 65(8):906–912

Jorm AF (2001) History of depression as a risk factor for dementia: an updated review. Aust NZ J Psychiatry 35(6):776–781CrossRef

Kudielka BM, Buske-Kirschbaum A, Hellhammer DH, Kirschbaum C (2004) HPA axis responses to laboratory psychosocial stress in healthy elderly adults, younger adults, and children: impact of age and gender. Psychoneuroendocrinology 29(1):83–98CrossRef

Lupien SJ, de Leon M, de Santi S, Convit A, Tarshish C, Nair NPV, Thakur M, McEwen BS, Hauger RL, Meaney MJ (1998) Cortisol levels during human aging predict hippocampal atrophy and memory deficits. Nat Neurosci 1(1):69–73CrossRef

Lupien SJ, Maheu F, Tu M, Fiocco A, Schramek TE (2007) The effects of stress and stress hormones on human cognition: implications for the field of brain and cognition. Brain Cogn 65(3):209–237CrossRef

McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan E (1984) Clinical diagnosis of Alzheimer’s disease: report of the NINCDS/ADRDA work group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 34:939–944CrossRef

Meredith W (1993) Measurement invariance, factor analysis and factorial invariance. Psychometrika 58(4):525–543CrossRef

Modrego PJ, Ferrández J (2004) Depression in patients with mild cognitive impairment increases the risk of developing dementia of Alzheimer type. Arch Neurol 61(8):1290–1293CrossRef

Muthén LK, Muthén BO (2007) Mplus user’s guide, 5th edn. Muthén & Muthén, Los Angeles, CA

Newcomer JW, Selke G, Melson AK, Hershey T, Craft S, Richards K, Alderson AL (1999) Decreased memory performance in healthy humans induced by stress-level cortisol treatment. Arch Gen Psychiatry 56(6):527–533CrossRef

Ownby RL, Crocco E, Acevedo A, John V, Loewenstein D (2006) Depression and risk for Alzheimer disease: systematic review, meta-analysis, and metaregression analysis. Arch Gen Psychiatry 63(5):530–538CrossRef

Penninx BWJH, Beekman ATF, Bandinelli S, Corsi AM, Bremmer M, Hoogendijk WJ, Guralnik JM, Ferrucci L (2007) Late-life depressive symptoms are associated with both hyperactivity and hypoactivity of the hypothalamo-pituitary-adrenal axis. Am J Geriatr Psychiatry 15(6):522–529CrossRef

Prina A, Deeg D, Brayne C, Beekman A, Huisman M (2012) The association between depressive symptoms and non-psychiatric hospitalisation in older adults. Plos ONE 7(4). doi:10.1371/journal.pone.0034821

Radloff LS (1977) The CES-D scale: a self report depression scale for research in the general population. Appl Psychol Meas 1:385–401CrossRef

Saczynski JS, Beiser A, Seshadri S, Auerbach S, Wolf PA, Au R (2010) Depressive symptoms and risk of dementia. The Framingham Heart Study. Neurology 75:35–41CrossRef

Sapolsky RM, Krey LC, McEwen BS (1986) The neuroendocrinology of stress and aging: the glucocorticoid cascade hypothesis. Endocr Rev 7:284–301CrossRef

Schumacker RE, Lomax RG (2010) A beginner’s guide to structural equation modeling. Routledge, New York

Sheikh JI, Yesavage JA (1986) Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clin Gerontol 5(1–2):165–173

Skoog I (1993) The prevalence of psychotic, depressive and anxiety syndromes in demented and non-demented 85-year-olds. Int J Geriatr Psychiatry 8(3):247–253CrossRef

Steyer R, Eid M, Schwenkmezger P (1997) Modeling true intraindividual change: true change as a latent variable. Method Psychol Res 2(1):21–33

Van den Kommer TN, Commijs HC, Aartsen MJ, Huisman, M, Deeg DJ, Beekman AT (2012) Depression and cognition: how do they interrelate in old age? Am J Geriatr Psychiatry (e-published)

Vinkers DJ, Gussekloo J, Stek ML, Westendorp RGJ, van der Mast RC (2004) Temporal relation between depression and cognitive impairment in old age: prospective population based study. Brit Med J 329:881–884CrossRef

Wilson RS, Barnes LL, de Leon CFM, Aggerwal NT, Schneider JS, Bach J, Pilat J, Beckett LA, Arnold SE, Evans DA, Bennett DA (2002) Depressive symptoms, cognitive decline, and risk of AD in older persons. Neurology 59(364):370

Wilson RS, Arnold SE, Beck TL, Bienias JL, Bennett DA (2008) Change in depressive symptoms during the prodromal phase of Alzheimer disease. Arch Gen Psychiatry 65(4):439–446CrossRef

Zimprich D, Martin M, Kliegel M (2003) Subjective cognitive complaints, memory performance, and depressive affect in old age: a change-oriented approach. Int J Aging Hum Dev 57(4):339–366CrossRef

Title: Depressive symptoms as predictor of dementia versus continuous cognitive decline: a 3-year prospective study
Authors: Andreas B. Neubauer
Hans-Werner Wahl
Horst Bickel
Publication date: 01-03-2013
Publisher: Springer Netherlands
Published in: European Journal of Ageing / Issue 1/2013
Print ISSN: 1613-9372
Electronic ISSN: 1613-9380
DOI: https://doi.org/10.1007/s10433-012-0246-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Depressive symptoms as predictor of dementia versus continuous cognitive decline: a 3-year prospective study

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2013

Erratum to: Unexpected retirement from full time work after age 62: consequences for life satisfaction in older Americans

Acknowledgement to reviewers

Development of a home visitation programme for the early detection of health problems in potentially frail community-dwelling older people by general practices

Leaving the labour market: the impact of exit routes from employment to retirement on health and wellbeing in old age

Values and adult age: findings from two cohorts of the European Social Survey

Gender and active ageing in Europe