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Age of major depression onset, depressive symptoms, and risk for subsequent dementia: results of the German Study on Ageing, Cognition, and Dementia in Primary Care Patients (AgeCoDe)

Published online by Cambridge University Press:  09 November 2012

K. Heser ,
F. Tebarth ,
B. Wiese ,
M. Eisele ,
H. Bickel ,
M. Köhler ,
E. Mösch ,
S. Weyerer ,
J. Werle  and
H.-H. König
...Show all authors
K. Heser*
Affiliation:
Department of Psychiatry, University of Bonn, Germany
F. Tebarth
Affiliation:
Department of Psychiatry, University of Bonn, Germany
B. Wiese
Affiliation:
Institute for Biometrics, Hannover Medical School, Germany
M. Eisele
Affiliation:
Department of Primary Medical Care, University Medical Centre, Hamburg-Eppendorf, Germany
H. Bickel
Affiliation:
Department of Psychiatry, Technical University, Munich, Germany
M. Köhler
Affiliation:
Department of Primary Medical Care, University Medical Centre, Hamburg-Eppendorf, Germany
E. Mösch
Affiliation:
Department of Psychiatry, Technical University, Munich, Germany
S. Weyerer
Affiliation:
Central Institute for Mental Health, Mannheim, Germany
J. Werle
Affiliation:
Central Institute for Mental Health, Mannheim, Germany
H.-H. König
Affiliation:
Department of Medical Sociology and Health Economics, University Medical Centre, Hamburg-Eppendorf, Germany
H. Leicht
Affiliation:
Department of Medical Sociology and Health Economics, University Medical Centre, Hamburg-Eppendorf, Germany
M. Pentzek
Affiliation:
Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Germany
A. Fuchs
Affiliation:
Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Germany
S. G. Riedel-Heller
Affiliation:
Department of Psychiatry, University of Leipzig, Germany
M. Luppa
Affiliation:
Department of Psychiatry, University of Leipzig, Germany
J. Prokein
Affiliation:
Institute for Biometrics, Hannover Medical School, Germany
M. Scherer
Affiliation:
Department of Primary Medical Care, University Medical Centre, Hamburg-Eppendorf, Germany
W. Maier
Affiliation:
Department of Psychiatry, University of Bonn, Germany DZNE, Center for Neurodegenerative Diseases, Bonn, Germany
M. Wagner
Affiliation:
Department of Psychiatry, University of Bonn, Germany DZNE, Center for Neurodegenerative Diseases, Bonn, Germany
*
*Address for correspondence: Ms. K. Heser, Department of Psychiatry, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany. (Email: [email protected])
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Abstract

Background

Whether late-onset depression is a risk factor for or a prodrome of dementia remains unclear. We investigated the impact of depressive symptoms and early- v. late-onset depression on subsequent dementia in a cohort of elderly general-practitioner patients (n = 2663, mean age = 81.2 years).

Method

Risk for subsequent dementia was estimated over three follow-ups (each 18 months apart) depending on history of depression, particularly age of depression onset, and current depressive symptoms using proportional hazard models. We also examined the additive prediction of incident dementia by depression beyond cognitive impairment.

Results

An increase of dementia risk for higher age cut-offs of late-onset depression was found. In analyses controlling for age, sex, education, and apolipoprotein E4 genotype, we found that very late-onset depression (aged ⩾70 years) and current depressive symptoms separately predicted all-cause dementia. Combined very late-onset depression with current depressive symptoms was specifically predictive for later Alzheimer's disease (AD; adjusted hazard ratio 5.48, 95% confidence interval 2.41–12.46, p < 0.001). This association was still significant after controlling for cognitive measures, but further analyses suggested that it was mediated by subjective memory impairment with worries.

Conclusions

Depression might be a prodrome of AD but not of dementia of other aetiology as very late-onset depression in combination with current depressive symptoms, possibly emerging as a consequence of subjectively perceived worrisome cognitive deterioration, was most predictive. As depression parameters and subjective memory impairment predicted AD independently of objective cognition, clinicians should take this into account.

Keywords

Alzheimer's diseasedepressive symptomsmajor depressionrisk for dementia
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 8 , August 2013 , pp. 1597 - 1610
Copyright
Copyright © Cambridge University Press 2012 

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