TY - JOUR
T1 - Trajectories of depressive symptoms in older adults and risk of dementia
AU - Kaup, Allison R.
AU - Byers, Amy L.
AU - Falvey, Cherie
AU - Simonsick, Eleanor M.
AU - Satterfield, Suzanne
AU - Ayonayon, Hilsa N.
AU - Smagula, Stephen F.
AU - Rubin, Susan M.
AU - Yaffe, Kristine
N1 - Funding Information:
This researchwas supported by contractsN01-AG-6-2101, N01-AG-6-2103, and N01-AG-6-2106 from the National Institute on Aging; by grant R01-AG028050 from the National Institute on Aging; by grant R01-NR012459 from the National Institute for Nursing Research; and in part by the Intramural Research Program of the National Institute on Aging. The research described hereinwas also supported in part by Career Development Award 1IK2RX001629 from the US Department of Veterans Affairs, Rehabilitation Research and Development Service (Dr Kaup); by research training grant T32 MH019986 from the National Institute of Mental Health (Dr Smagula); by grant K24AG031155 from the National Institute on Aging (Dr Yaffe); and by the Department of Veterans Affairs Office of Academic Affiliations Advanced Fellowship Program in Mental Illness Research and Treatment, the Medical Research Service of the San Francisco Veterans Affairs Medical Center, and the Department of Veterans Affairs Sierra-Pacific Mental Illness Research, Education, and Clinical Center.
Publisher Copyright:
© 2016 American Medical Association. All rights reserved.
PY - 2016/5
Y1 - 2016/5
N2 - Importance: Depression has been identified as a risk factor for dementia. However,most studies have measured depressive symptoms at only one time point, and older adults may show different patterns of depressive symptoms over time. O. Objective: To investigate the association between trajectories of depressive symptoms and risk of dementia in older adults. Design, Setting, and Participants: Thiswas a prospective cohort investigation of black and white community-dwelling older adults in the Health, Aging, and Body Composition study. Participants were enrolled between May 1997 and June 1998 and followed up through 2001-2002. The dates of this analysis were September 2014 to December 2015. The setting was community research centers in Memphis, Tennessee, and Pittsburgh, Pennsylvania. Trajectories of depressive symptoms were assessed from baseline to year 5. Symptoms were measured with the Center for Epidemiologic Studies Depression Scale Short Form, and trajectories were calculated using latent class growth curve analysis. Main Outcomes and Measures: Incident dementia through year 11, determined by dementia medication use, hospital records, or significant cognitive decline (≥1.5 SD race-specific decline on the Modified Mini-Mental State Examination).We examined the association between depressive symptom trajectories and dementia incidence using Cox proportional hazards regression models adjusted for demographics, health factors that differed between groups, and cognition during the depressive symptom assessment period (baseline to year 5). RESULTS The analytic cohort included 2488 black and white older adults with repeated depressive symptom assessments from baseline to year 5 who were free of dementia throughout that period. Their mean (SD) age at baseline was 74.0 (2.8) years, and 53.1% (n = 1322) were female. The following 3 depressive symptom trajectories were identified: consistently minimal symptoms (62.0% [n = 1542] of participants), moderate and increasing symptoms (32.2%[n = 801] of participants), and high and increasing symptoms (5.8% [n = 145] of participants). Compared with the consistently minimal trajectory, having a high and increasing depressive symptom trajectory was associated with significantly increased risk of dementia (fully adjusted hazard ratio, 1.94; 95%CI, 1.30-2.90), while the moderate and increasing trajectory was not associated with risk of dementia after full adjustment. Sensitivity analyses indicated that the high and increasing trajectory was associated with dementia incidence, while depressive symptoms at individual time points were not. Conclusions and Relevance: Older adults with a longitudinal pattern of high and increasing depressive symptoms are at high risk for dementia. Individuals' trajectory of depressive symptoms may inform dementia risk more accurately than one-time assessment of depressive symptoms.
AB - Importance: Depression has been identified as a risk factor for dementia. However,most studies have measured depressive symptoms at only one time point, and older adults may show different patterns of depressive symptoms over time. O. Objective: To investigate the association between trajectories of depressive symptoms and risk of dementia in older adults. Design, Setting, and Participants: Thiswas a prospective cohort investigation of black and white community-dwelling older adults in the Health, Aging, and Body Composition study. Participants were enrolled between May 1997 and June 1998 and followed up through 2001-2002. The dates of this analysis were September 2014 to December 2015. The setting was community research centers in Memphis, Tennessee, and Pittsburgh, Pennsylvania. Trajectories of depressive symptoms were assessed from baseline to year 5. Symptoms were measured with the Center for Epidemiologic Studies Depression Scale Short Form, and trajectories were calculated using latent class growth curve analysis. Main Outcomes and Measures: Incident dementia through year 11, determined by dementia medication use, hospital records, or significant cognitive decline (≥1.5 SD race-specific decline on the Modified Mini-Mental State Examination).We examined the association between depressive symptom trajectories and dementia incidence using Cox proportional hazards regression models adjusted for demographics, health factors that differed between groups, and cognition during the depressive symptom assessment period (baseline to year 5). RESULTS The analytic cohort included 2488 black and white older adults with repeated depressive symptom assessments from baseline to year 5 who were free of dementia throughout that period. Their mean (SD) age at baseline was 74.0 (2.8) years, and 53.1% (n = 1322) were female. The following 3 depressive symptom trajectories were identified: consistently minimal symptoms (62.0% [n = 1542] of participants), moderate and increasing symptoms (32.2%[n = 801] of participants), and high and increasing symptoms (5.8% [n = 145] of participants). Compared with the consistently minimal trajectory, having a high and increasing depressive symptom trajectory was associated with significantly increased risk of dementia (fully adjusted hazard ratio, 1.94; 95%CI, 1.30-2.90), while the moderate and increasing trajectory was not associated with risk of dementia after full adjustment. Sensitivity analyses indicated that the high and increasing trajectory was associated with dementia incidence, while depressive symptoms at individual time points were not. Conclusions and Relevance: Older adults with a longitudinal pattern of high and increasing depressive symptoms are at high risk for dementia. Individuals' trajectory of depressive symptoms may inform dementia risk more accurately than one-time assessment of depressive symptoms.
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U2 - 10.1001/jamapsychiatry.2016.0004
DO - 10.1001/jamapsychiatry.2016.0004
M3 - Article
C2 - 26982217
AN - SCOPUS:84973402061
SN - 2168-622X
VL - 73
SP - 525
EP - 531
JO - JAMA psychiatry
JF - JAMA psychiatry
IS - 5
ER -