Kathrin Heser1, Markus Bleckwenn2, Birgitt Wiese3, Silke Mamone3, Steffi G Riedel-Heller4, Janine Stein4, Dagmar Lühmann5, Tina Posselt5, Angela Fuchs6, Michael Pentzek6, Siegfried Weyerer7, Jochen Werle7, Dagmar Weeg8, Horst Bickel8, Christian Brettschneider9, Hans-Helmut König9, Wolfgang Maier1,10, Martin Scherer5, Michael Wagner1,10. 1. Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany. 2. Department of General Practice and Family Medicine, University of Bonn, Bonn, Germany. 3. Working Group Medical Statistics and IT Infrastructure, Institute of General Practice, Hannover Medical School, Hannover, Germany. 4. Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany. 5. Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 6. Institute of General Practice, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany. 7. Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany. 8. Department of Psychiatry, Technical University Munich, Munich, Germany. 9. Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 10. DZNE, Center for Neurodegenerative Diseases, Bonn, Germany.
Abstract
BACKGROUND: Late-life depression is frequently accompanied by cognitive impairments. OBJECTIVE: Whether these impairments indicate a prodromal state of dementia, or are a symptomatic expression of depression per se is not well-studied. METHODS: In a cohort of very old initially non-demented primary care patients (n = 2,709, mean age = 81.1 y), cognitive performance was compared between groups of participants with or without elevated depressive symptoms and with or without subsequent dementia using ANCOVA (adjusted for age, sex, and education). Logistic regression analyses were computed to predict subsequent dementia over up to six years of follow-up. The same analytical approach was performed for lifetime major depression. RESULTS: Participants with elevated depressive symptoms without subsequent dementia showed only small to medium cognitive deficits. In contrast, participants with depressive symptoms with subsequent dementia showed medium to very large cognitive deficits. In adjusted logistic regression models, learning and memory deficits predicted the risk for subsequent dementia in participants with depressive symptoms. Participants with a lifetime history of major depression without subsequent dementia showed no cognitive deficits. However, in adjusted logistic regression models, learning and orientation deficits predicted the risk for subsequent dementia also in participants with lifetime major depression. CONCLUSION: Marked cognitive impairments in old age depression should not be dismissed as "depressive pseudodementia", but require clinical attention as a possible sign of incipient dementia. Non-depressed elderly with a lifetime history of major depression, who remained free of dementia during follow-up, had largely normal cognitive performance.
BACKGROUND: Late-life depression is frequently accompanied by cognitive impairments. OBJECTIVE: Whether these impairments indicate a prodromal state of dementia, or are a symptomatic expression of depression per se is not well-studied. METHODS: In a cohort of very old initially non-demented primary care patients (n = 2,709, mean age = 81.1 y), cognitive performance was compared between groups of participants with or without elevated depressive symptoms and with or without subsequent dementia using ANCOVA (adjusted for age, sex, and education). Logistic regression analyses were computed to predict subsequent dementia over up to six years of follow-up. The same analytical approach was performed for lifetime major depression. RESULTS:Participants with elevated depressive symptoms without subsequent dementia showed only small to medium cognitive deficits. In contrast, participants with depressive symptoms with subsequent dementia showed medium to very large cognitive deficits. In adjusted logistic regression models, learning and memory deficits predicted the risk for subsequent dementia in participants with depressive symptoms. Participants with a lifetime history of major depression without subsequent dementia showed no cognitive deficits. However, in adjusted logistic regression models, learning and orientation deficits predicted the risk for subsequent dementia also in participants with lifetime major depression. CONCLUSION: Marked cognitive impairments in old age depression should not be dismissed as "depressive pseudodementia", but require clinical attention as a possible sign of incipient dementia. Non-depressed elderly with a lifetime history of major depression, who remained free of dementia during follow-up, had largely normal cognitive performance.
Authors: Aleksandra K Lebedeva; Eric Westman; Tom Borza; Mona K Beyer; Knut Engedal; Dag Aarsland; Geir Selbaek; Asta K Haberg Journal: Front Aging Neurosci Date: 2017-02-02 Impact factor: 5.750