Midlife vs late-life depressive symptoms and risk of dementia

Deborah E. Barnes, Kristine Yaffe, Amy L. Byers, Mark McCormick, Catherine Schaefer, Rachel Whitmer

Research output: Contribution to journalArticle

183 Citations (Scopus)

Abstract

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 thirtyfive long-term Kaiser Permanente members. Main Outcome Measure: Any medical record diagnosis of dementia or neurology clinic diagnosis of ADor 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 latelife symptoms only (1.72 [1.54-1.92]), and 80% for both (1.77 [1.52-2.06]). When we examinedADand 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 latelife 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.

Original languageEnglish (US)
Pages (from-to)493-498
Number of pages6
JournalArchives of General Psychiatry
Volume69
Issue number5
DOIs
StatePublished - May 1 2012
Externally publishedYes

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Dementia
Vascular Dementia
Depression
Alzheimer Disease
Depressive Symptoms
Neurology
Proportional Hazards Models
Medical Records
Comorbidity
Cohort Studies
Retrospective Studies
Odds Ratio
Demography
Outcome Assessment (Health Care)
Alzheimer's Disease

ASJC Scopus subject areas

  • Arts and Humanities (miscellaneous)
  • Psychiatry and Mental health

Cite this

Midlife vs late-life depressive symptoms and risk of dementia. / Barnes, Deborah E.; Yaffe, Kristine; Byers, Amy L.; McCormick, Mark; Schaefer, Catherine; Whitmer, Rachel.

In: Archives of General Psychiatry, Vol. 69, No. 5, 01.05.2012, p. 493-498.

Research output: Contribution to journalArticle

Barnes, Deborah E. ; Yaffe, Kristine ; Byers, Amy L. ; McCormick, Mark ; Schaefer, Catherine ; Whitmer, Rachel. / Midlife vs late-life depressive symptoms and risk of dementia. In: Archives of General Psychiatry. 2012 ; Vol. 69, No. 5. pp. 493-498.
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N2 - 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 thirtyfive long-term Kaiser Permanente members. Main Outcome Measure: Any medical record diagnosis of dementia or neurology clinic diagnosis of ADor 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 latelife symptoms only (1.72 [1.54-1.92]), and 80% for both (1.77 [1.52-2.06]). When we examinedADand 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 latelife 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.

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