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Cited by 302Dementia and Cognitive Impairment ResearchAging, Health, and DisabilityHealth disparities and outcomes

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Trajectories of Depressive Symptoms in Older Adults and Risk of Dementia

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Kaup, Allison R., Byers, Amy L., Falvey, Cherie, Simonsick, Eleanor M., Satterfield, Suzanne, Ayonayon, Hilsa N., Smagula, Stephen F., Rubin, Susan M., Yaffe, Kristine·2016·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2016.0004PMC PMC5082978
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Abstract

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. OBJECTIVE: To investigate the association between trajectories of depressive symptoms and risk of dementia in older adults. DESIGN, SETTING, AND PARTICIPANTS: This was 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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  • Late life depression is thought to be an early symptom of dementia, whereas studies of whether midlife depression is a risk factor for later life dementia have had mixed findings.

    “In particular, late life depression is thought to be an early symptom of dementia,18 19 whereas studies of whether midlife depression is a risk factor for later life dementia have had mixed findings.20 21”

    From Anticholinergic drugs and risk of dementia: case-control study (2018) · cites this paper as [18]

    The Discussion says depressive symptoms in older adults may be a reaction to early cognitive decline or a sign of an underlying neurodegenerative process, supporting the late-life part of the sentence as a possibility. The paper studies older adults and does not report mixed findings about midlife depression as a risk factor for later-life dementia (searched: midlife; mixed findings). (LLM, conf=0.84)

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Research works printed but not linked: 29

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Metadata

Authors
Kaup, A. R., Byers, A. L., Falvey, C., Simonsick, E. M., Satterfield, S., Ayonayon, H. N., Smagula, S. F., Rubin, S. M., & Yaffe, K.
Affiliations
  • San Francisco VA Medical Center (US)
  • University of California, San Francisco (US)
  • National Institute on Aging (US)
  • University of Tennessee Health Science Center (US)
  • University of Pittsburgh (US)
Corresponding author
Kaup, Allison R.
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2016-05-01
Volume
73
Issue
5
Pages
525
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2016.0004
PMC
PMC5082978
OpenAlex
W2297804643
Cited by
302
References
4
Citations by year
2026: 25 · 2025: 36 · 2024: 39 · 2023: 28 · 2022: 35 · 2021: 33 · 2020: 31 · 2019: 20 · 2018: 24 · 2017: 20 · 2016: 9
FWCI
16.79
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • U.S. Department of Veterans Affairs (IK2 RX001629)
  • National Institute on Aging (R01AG028050, K24AG031155)
  • National Institute of Mental Health (T32MH019986)
  • National Institute of Nursing Research (R01NR012459)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
  • Social Sciences › Health › Health disparities and outcomes
Keywords
depressive symptoms, dementia risk, older adults, dementia incidence, cognitive decline, racial differences, Black and White older adults, community-dwelling older adults, Health, Aging, and Body Composition Study, neurodegeneration, neuroinflammation
MeSH terms
Aged, Alzheimer Disease, Depressive Disorder, Female, Humans, Male, Prospective Studies, Risk Factors, Sensitivity and Specificity, United States, Cohort Studies, Incidence, Disease Progression

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