Depressive symptoms (DS) in the elderly have been implicated in cognitive decline, and are more frequent in patients with white matter changes (WMC). Our aim was to ascertain if DS influence cognition in an elderly population with WMC.

The LADIS (Leukoaraiosis and Disability) is a prospective European study that evaluates the impact of WMC on the transition of independent elderly subjects into disability. Subjects were enrolled due to minor complaints without impact in daily-living activities, and presence of WMC. Subjects were evaluated at baseline and yearly during 3 years with a comprehensive clinical and functional protocol. DS were recorded with the Geriatric Depression Scale (GDS). Major depression was classified according to the DSM-IV criteria. Dementia and cognitive decline not dementia were diagnosed according to usual clinical criteria. MRI was performed at entry and at the end of the study. WMC severity was rated according to the Fazeka's scale.

639 subjects were included (74.1 ± 5 years old, 55% women, 9.6±3.8 years of schooling). 89% (568), 78.4% (501), and 75% (480) of the patients from the initial sample were followed-up in clinical visit at year 1, 2 and 3. At the end of the study 90 patients were demented and 147 patients had cognitive impairment not dementia. Using survival Cox regression we found that depressive symptoms were independent predictors of cognitive impairment independently of age, education, gender, WMC severity and temporal atrophy.

Depressive symptoms are independent predictor of cognitive decline in an independent elderly population with WMC.