Depressive Symptoms and Cognitive Decline in Community-Dwelling Older Adults

Authors

  • Sebastian Köhler PhD,

    1. From the *Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, European Graduate School of Neuroscience, Maastricht University, Maastricht, the Netherlands; Wolfson Research Centre, Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom; and Faculty of Psychology and Education, VU University, Amsterdam, the Netherlands.
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  • Martin P.J. van Boxtel MD, PhD,

    1. From the *Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, European Graduate School of Neuroscience, Maastricht University, Maastricht, the Netherlands; Wolfson Research Centre, Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom; and Faculty of Psychology and Education, VU University, Amsterdam, the Netherlands.
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  • Jim van Os MD, PhD,

    1. From the *Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, European Graduate School of Neuroscience, Maastricht University, Maastricht, the Netherlands; Wolfson Research Centre, Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom; and Faculty of Psychology and Education, VU University, Amsterdam, the Netherlands.
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  • Alan J. Thomas PhD,

    1. From the *Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, European Graduate School of Neuroscience, Maastricht University, Maastricht, the Netherlands; Wolfson Research Centre, Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom; and Faculty of Psychology and Education, VU University, Amsterdam, the Netherlands.
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  • John T. O'Brien DM,

    1. From the *Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, European Graduate School of Neuroscience, Maastricht University, Maastricht, the Netherlands; Wolfson Research Centre, Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom; and Faculty of Psychology and Education, VU University, Amsterdam, the Netherlands.
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  • Jelle Jolles PhD,

    1. From the *Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, European Graduate School of Neuroscience, Maastricht University, Maastricht, the Netherlands; Wolfson Research Centre, Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom; and Faculty of Psychology and Education, VU University, Amsterdam, the Netherlands.
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  • Frans R.J. Verhey MD, PhD,

    1. From the *Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, European Graduate School of Neuroscience, Maastricht University, Maastricht, the Netherlands; Wolfson Research Centre, Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom; and Faculty of Psychology and Education, VU University, Amsterdam, the Netherlands.
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  • Judith Allardyce MD, MPH, PhD

    1. From the *Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, European Graduate School of Neuroscience, Maastricht University, Maastricht, the Netherlands; Wolfson Research Centre, Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom; and Faculty of Psychology and Education, VU University, Amsterdam, the Netherlands.
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Address correspondence to Sebastian Köhler, Department of Psychiatry and Neuropsychology, P.O. Box 616 (DOT12), 6200 MD Maastricht, the Netherlands. E-mail: s.koehler@np.unimaas.nl

Abstract

OBJECTIVES: To examine the temporal association between depressive symptoms and cognitive functioning and estimate the effect measure modification of the apolipoprotein E (APOE) ɛ4 allele on this relationship.

DESIGN: Prospective cohort study.

SETTING: General community.

PARTICIPANTS: Population-based sample of 598 cognitively intact older adults aged 60 and older, with re-assessments after 3 (N=479) and 6 years (N=412).

MEASUREMENTS: Depressive symptoms (Symptom Checklist) and neurocognitive functioning (memory, Visual Verbal Learning Test; attention, Stroop Color–Word Test; processing speed, Letter Digit Substitution Test; general cognition, Mini-Mental State Examination). Longitudinal associations were assessed using linear mixed models. The risk for cognitive impairment, no dementia (CIND) was examined using logistic regression.

RESULTS: Adjusting for age, sex, education, and baseline cognition, the rate of change in memory z-scores was 0.00, −0.11, −0.20, and −0.37 for those in the lowest (reference group), second, third, and highest depressive symptom quartiles at baseline, respectively (P<.001 for highest vs lowest quartile). The odds ratios for developing CIND with amnestic features were 1.00, 0.87, 0.69, and 2.98 for the four severity groups (P=.05 for highest vs lowest quartile). Associations were strongest for those with persistent depressive symptoms, defined as high depressive symptoms at baseline and at least one follow-up visit. Results were similar for processing speed and global cognitive function but were not as strong for attention. No APOE interaction was observed.

CONCLUSION: Depression and APOE act independently to increase the risk for cognitive decline and may provide targets for prevention and early treatment.

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