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Cross-sectional and prospective inter-relationships between depressive symptoms, vascular disease and cognition in older adults

Published online by Cambridge University Press:  29 October 2018

Louise Mewton ,
Simone Reppermund ,
John Crawford ,
David Bunce ,
Wei Wen  and
Perminder Sachdev
Louise Mewton*
Affiliation:
Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
Simone Reppermund
Affiliation:
Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney, Australia Department of Developmental Disability Neuropsychiatry, UNSW Medicine, University of New South Wales, Sydney
John Crawford
Affiliation:
Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney, Australia
David Bunce
Affiliation:
Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney, Australia Faculty of Medicine and Health, School of Psychology, University of Leeds, Leeds, UK
Wei Wen
Affiliation:
Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney, Australia Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, Australia
Perminder Sachdev
Affiliation:
Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney, Australia Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, Australia
*
Author for correspondence: Louise Mewton, E-mail: [email protected], [email protected]
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Abstract

Background

It has been proposed that vascular disease is the mechanism linking depression and cognition, but prospective studies have not supported this hypothesis. This study aims to investigate the inter-relationships between depressive symptoms, cognition and cerebrovascular disease using a well-characterised prospective cohort.

Method

Data came from waves 1 (2005–2007) and 2 (2007–2009) of the Sydney Memory and Ageing Study (n = 462; mean age = 78.3 years).

Results

At wave 1, there was an association between depressive symptoms and white matter hyperintensity (WMH) volume [b = 0.016, t(414) = 2.34, p = 0.020]. Both depressive symptoms [b = −0.058, t(413) = −2.64, p = 0.009] and WMH volume [b = −0.011, t(413) = −3.77, p < 0.001], but not stroke/transient ischaemic attack (TIA) [b = −0.328, t(413) = −1.90, p = 0.058], were independently associated with lower cognition. Prospectively, cerebrovascular disease was not found to predict increasing depressive symptoms [stroke/TIA: b = −0.349, t(374.7) = −0.76, p = 0.448; WMH volume: b = 0.007, t(376.3) = 0.875, p = 0.382]. Depressive symptoms predicted increasing WMH severity [b = 0.012, t(265.9) = −3.291, p = 0.001], but not incident stroke/TIA (odds ratio = 0.995; CI 0.949–1.043; p = 0.820). When examined in separate models, depressive symptoms [b = −0.027, t(373.5) = −2.16, p = 0.032] and a history of stroke/TIA [b = −0.460, t(361.2) = −4.45, p < 0.001], but not WMH volume [b = 0.001, t(362.3) = −0.520, p = 0.603], predicted declines in cognition. When investigated in a combined model, a history of stroke/TIA remained a predictor of cognitive decline [b = −0.443, t(360.6) = −4.28, p < 0.001], whilst depressive symptoms did not [b = −0.012, t(359.7) = −0.96, p = 0.336].

Conclusions

This study is contrasted with previous prospective studies which indicate that depressive symptoms predict cognitive decline independently of vascular disease. Future research should focus on further exploring the vascular mechanisms underpinning the relationship between depressive symptoms and cognition.

Keywords

Cognitioncohort studydepressionvascular disease
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 13 , October 2019 , pp. 2168 - 2176
Copyright
Copyright © Cambridge University Press 2018 

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References

Alexopoulos, GS, Meyers, BS, Young, RC, Campbell, S, Silbersweig, D and Charlson, M (1997 a) ‘Vascular depression’ hypothesis. Archives of General Psychiatry 54, 915.Google Scholar
Alexopoulos, GS, Meyers, BS, Young, RC, Kakuma, T, Silbersweig, D and Charlson, M (1997 b) Clinically defined vascular depression. American Journal of Psychiatry 154, 562–565.Google Scholar
Alexopoulos, GS, Meyers, BS, Young, RC, Kalayam, B, Kakuma, T, Gabrielle, M, Sirey, JA and Hull, J (2000) Executive dysfunction and long-term outcomes of geriatric depression. Archives of General Psychiatry 57, 285–290.Google Scholar
Alexopoulos, GS, Kiosses, DN, Murphy, C and Heo, M (2004) Executive dysfunction, heart disease burden, and remission of geriatric depression. Neuropsychopharmacology 29, 2278–2284.Google Scholar
Alexopoulos, GS, Raue, PJ, Kiosses, DN, Mackin, RS, Kanellopoulos, D, Mcculloch, C and Areán, PA (2011) Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction: effect on disability. Archives of General Psychiatry 68, 33–41.Google Scholar
Areán, PA, Raue, P, Mackin, RS, Kanellopoulos, D, Mcculloch, C and Alexopoulos, GS (2010) Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction. American Journal of Psychiatry 167, 1391–1398.Google Scholar
Ayerbe, L, Ayis, S, Wolfe, CD and Rudd, AG (2013) Natural history, predictors and outcomes of depression after stroke: systematic review and meta-analysis. The British Journal of Psychiatry 202, 14–21.Google Scholar
Baldwin, R, Jeffries, S, Jackson, A, Sutcliffe, C, Thacker, N, Scott, M and Burns, A (2004) Treatment response in late-onset depression: relationship to neuropsychological, neuroradiological and vascular risk factors. Psychological Medicine 34, 125–136.Google Scholar
Barch, DM, D'Angelo, G, Pieper, C, Wilkins, CH, Welsh-Bohmer, K, Taylor, W, Garcia, KS, Gersing, K, Doraiswamy, PM and Sheline, YI (2012) Cognitive improvement following treatment in late-life depression: relationship to vascular risk and age of onset. The American Journal of Geriatric Psychiatry 20, 682–690.Google Scholar
Barnes, DE and Yaffe, K (2011) The projected effect of risk factor reduction on Alzheimer's disease prevalence. The Lancet Neurology 10, 819–828.Google Scholar
Barnes, DE, Alexopoulos, GS, Lopez, OL, Williamson, JD and Yaffe, K (2006) Depressive symptoms, vascular disease, and mild cognitive impairment: findings from the Cardiovascular Health Study. Archives of General Psychiatry 63, 273–279.Google Scholar
Beekman, A, Deeg, D, Braam, A, Smit, J and Van Tilburg, W (1997) Consequences of major and minor depression in later life: a study of disability, well-being and service utilization. Psychological Medicine 27, 1397–1409.Google Scholar
Benton, AL (1967) Problems of test construction in the field of aphasia. Cortex 3, 32–58.Google Scholar
Benton, AL, Sivan, AB and Spreen, O (1966) Der Benton Test, 7th Edn. Bern: Huber.Google Scholar
Brickman, AM, Muraskin, J and Zimmerman, ME (2009) Structural neuroimaging in Alzheimer's disease: do white matter hyperintensities matter? Dialogues in Clinical Neuroscience 11, 181.Google Scholar
Brink, T (1982) Geriatric depression and hypochondriasis: incidence, interaction, assessment and treatment. Psychotherapy: Theory, Research & Practice 19, 506.Google Scholar
Bunce, D, Batterham, PJ, Christensen, H and Mackinnon, AJ (2014) Causal associations between depression symptoms and cognition in a community-based cohort of older adults. The American Journal of Geriatric Psychiatry 22, 1583–1591.Google Scholar
Butters, MA, Becker, JT, Nebes, RD, Zmuda, MD, Mulsant, BH, Pollock, BG and Reynolds, CF III (2000) Changes in cognitive functioning following treatment of late-life depression. American Journal of Psychiatry 157, 1949–1954.Google Scholar
Butters, MA, Whyte, EM, Nebes, RD, Begley, AE, Dew, MA, Mulsant, BH, Zmuda, MD, Bhalla, R, Meltzer, CC and Pollock, BG (2004) The nature and determinants of neuropsychological functioning in late-life depression. Archives of General Psychiatry 61, 587–595.Google Scholar
Byers, AL and Yaffe, K (2011) Depression and risk of developing dementia. Nature Reviews Neurology 7, 323–331.Google Scholar
Debette, S and Markus, H (2010) The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis. The British Medical Journal 341, c3666.Google Scholar
Fang, J and Cheng, Q (2009) Etiological mechanisms of post-stroke depression: a review. Neurological Research 31, 904–909.Google Scholar
Fastenau, PS, Denburg, NL and Mauer, BA (1998) Parallel short forms for the Boston Naming Test: psychometric properties and norms for older adults. Journal of Clinical and Experimental Neuropsychology 20, 828–834.Google Scholar
Ferketich, AK, Schwartzbaum, JA, Frid, DJ and Moeschberger, ML (2000) Depression as an antecedent to heart disease among women and men in the NHANES I study. Archives of Internal Medicine 160, 1261–1268.Google Scholar
Ferrari, AJ, Charlson, FJ, Norman, RE, Patten, SB, Freedman, G, Murray, CJ, Vos, T and Whiteford, HA (2013) Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS Medicine 10, e1001547.Google Scholar
Folstein, MF, Folstein, SE and Mchugh, PR (1975) ‘Mini-mental state’: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12, 189–198.Google Scholar
Freiheit, EA, Hogan, DB, Eliasziw, M, Patten, SB, Demchuk, AM, Faris, P, Anderson, T, Galbraith, D, Parboosingh, JS and Ghali, WA (2012) A dynamic view of depressive symptoms and neurocognitive change among patients with coronary artery disease. Archives of General Psychiatry 69, 244–255.Google Scholar
Goodkind, MS, Gallagher-Thompson, D, Thompson, LW, Kesler, SR, Anker, L, Flournoy, J, Berman, MP, Holland, JM and O'Hara, RM (2015) The impact of executive function on response to cognitive behavioral therapy in late-life depression. International Journal of Geriatric Psychiatry 31, 334–339.Google Scholar
Gordon, WA and Hibbard, MR (1997) Poststroke depression: an examination of the literature. Archives of Physical Medicine and Rehabilitation 78, 658–663.Google Scholar
Hackett, ML and Pickles, K (2014) Part I: frequency of depression after stroke: an updated systematic review and meta-analysis of observational studies. International Journal of Stroke 9, 1017–1025.Google Scholar
Herrmann, N, Mittmann, N, Silver, IL, Shulman, KI, Busto, UA, Shear, NH and Naranjo, CA (1996) A validation study of the Geriatric Depression Scale short form. International Journal of Geriatric Psychiatry 11, 457–460.Google Scholar
Jorge, RE, Moser, DJ, Acion, L and Robinson, RG (2008) Treatment of vascular depression using repetitive transcranial magnetic stimulation. Archives of General Psychiatry 65, 268–276.Google Scholar
Kalayam, B and Alexopoulos, GS (1999) Prefrontal dysfunction and treatment response in geriatric depression. Archives of General Psychiatry 56, 713–718.Google Scholar
Kaplan, E, Goodglass, H and Weintraub, S (2001) The Boston Naming Test. Baltimore: Lippincott, Williams & Wilkins.Google Scholar
Khalaf, A, Edelman, K, Tudorascu, D, Andreescu, C, Reynolds, CF and Aizenstein, H (2015) White matter hyperintensity accumulation during treatment of late-life depression. Neuropsychopharmacology 40, 3027–3035.Google Scholar
Krishnan, K, Hays, JC and Blazer, DG (1997) MRI-defined vascular depression. American Journal of Psychiatry 154, 497–501.Google Scholar
Leblanc, GG, Meschia, JF, Stuss, DT and Hachinski, V (2006) Genetics of vascular cognitive impairment. Stroke 37, 248–255.Google Scholar
Liebetrau, M, Steen, B and Skoog, I (2008) Depression as a risk factor for the incidence of first-ever stroke in 85-year-olds. Stroke 39, 1960–1965.Google Scholar
Luchsinger, JA, Honig, LS, Tang, MX and Devanand, DP (2008) Depressive symptoms, vascular risk factors, and Alzheimer's disease. International Journal of Geriatric Psychiatry 23, 922–928.Google Scholar
Lutz, W, Sanderson, W and Scherbov, S (2008) The coming acceleration of global population ageing. Nature 451, 716.Google Scholar
Mclennan, SN and Mathias, JL (2010) The depression-executive dysfunction (DED) syndrome and response to antidepressants: a meta-analytic review. International Journal of Geriatric Psychiatry 25, 933–944.Google Scholar
Morimoto, SS, Gunning, FM, Murphy, CF, Kanellopoulos, D, Kelly, RE and Alexopoulos, GS (2011) Executive function and short-term remission of geriatric depression: the role of semantic strategy. The American Journal of Geriatric Psychiatry 19, 115–122.Google Scholar
Murray, CJ, Vos, T, Lozano, R, Naghavi, M, Flaxman, AD, Michaud, C, Ezzati, M, Shibuya, K, Salomon, JA and Abdalla, S (2012) Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet 380, 2197–2223.Google Scholar
Nakano, Y, Baba, H, Maeshima, H, Kitajima, A, Sakai, Y, Baba, K, Suzuki, T, Mimura, M and Arai, H (2008) Executive dysfunction in medicated, remitted state of major depression. Journal of Affective Disorders 111, 46–51.Google Scholar
Nebes, RD, Butters, M, Mulsant, B, Pollock, B, Zmuda, M, Houck, P and Reynolds, C (2000) Decreased working memory and processing speed mediate cognitive impairment in geriatric depression. Psychological Medicine 30, 679–691.Google Scholar
Nebes, RD, Pollock, BG, Houck, PR, Butters, MA, Mulsant, BH, Zmuda, MD and Reynolds, CF (2003) Persistence of cognitive impairment in geriatric patients following antidepressant treatment: a randomized, double-blind clinical trial with nortriptyline and paroxetine. Journal of Psychiatric Research 37, 99–108.Google Scholar
O'Brien, JT, Lloyd, A, Mckeith, I, Gholkar, A and Ferrier, N (2004) A longitudinal study of hippocampal volume, cortisol levels, and cognition in older depressed subjects. American Journal of Psychiatry 161, 2081–2090.Google Scholar
Pan, A, Sun, Q, Okereke, OI, Rexrode, KM and Hu, FB (2011) Depression and risk of stroke morbidity and mortality: a meta-analysis and systematic review. JAMA 306, 1241–1249.Google Scholar
Prince, M, Bryce, R, Albanese, E, Wimo, A, Ribeiro, W and Ferri, CP (2013) The global prevalence of dementia: a systematic review and metaanalysis. Alzheimer's & Dementia 9, 63–75, e2.Google Scholar
Prince, MJ, Wu, F, Guo, Y, Robledo, LMG, O'Donnell, M, Sullivan, R and Yusuf, S (2015) The burden of disease in older people and implications for health policy and practice. The Lancet 385, 549–562.Google Scholar
Prins, ND and Scheltens, P (2015) White matter hyperintensities, cognitive impairment and dementia: an update. Nature Reviews Neurology 11, 157–166.Google Scholar
Prins, ND, Van Dijk, EJ, Den Heijer, T, Vermeer, SE, Jolles, J, Koudstaal, PJ, Hofman, A and Breteler, MM (2005) Cerebral small-vessel disease and decline in information processing speed, executive function and memory. Brain 128, 2034–2041.Google Scholar
Reitan, RM and Wolfson, D (1993) The Halstead-Reitan Neuropsychological Test Battery: Theory and Clinical Interpretation, 2nd Edn. Tucson, AZ: Neuropsychology Press.Google Scholar
Reppermund, S and Tsang, RSM (2016) The risk relationship between depression and CVD during ageing. In Baune, B and Tully, P (eds), Cardiovascular Diseases and Depression. Cham: Springer.Google Scholar
Reppermund, S, Brodaty, H, Crawford, J, Kochan, N, Slavin, M, Trollor, J, Draper, B and Sachdev, P (2011) The relationship of current depressive symptoms and past depression with cognitive impairment and instrumental activities of daily living in an elderly population: The Sydney Memory and Ageing Study. Journal of Psychiatric Research 45, 1600–1607.Google Scholar
Reppermund, S, Zhuang, L, Wen, W, Slavin, MJ, Trollor, JN, Brodaty, H and Sachdev, PS (2014) White matter integrity and late-life depression in community-dwelling individuals: diffusion tensor imaging study using tract-based spatial statistics. The British Journal of Psychiatry 205, 315–320.Google Scholar
Rey, A (1964) L'Examen Clinique en Psychologie. Paris: Presses Universitaires de France.Google Scholar
Robinson, RG and Jorge, RE (2015) Post-stroke depression: a review. American Journal of Psychiatry 173, 221–231.Google Scholar
Sachdev, PS, Brodaty, H, Reppermund, S, Kochan, NA, Trollor, JN, Draper, B, Slavin, MJ, Crawford, J, Kang, K and Broe, GA (2010) The Sydney Memory and Ageing Study (MAS): methodology and baseline medical and neuropsychiatric characteristics of an elderly epidemiological non-demented cohort of Australians aged 70–90 years. International Psychogeriatrics 22, 1248–1264.Google Scholar
Saczynski, JS, Beiser, A, Seshadri, S, Auerbach, S, Wolf, P and Au, R (2010) Depressive symptoms and risk of dementia The Framingham Heart Study. Neurology 75, 35–41.Google Scholar
Salaycik, KJ, Kelly-Hayes, M, Beiser, A, Nguyen, A-H, Brady, SM, Kase, CS and Wolf, PA (2007) Depressive symptoms and risk of stroke. Stroke 38, 16–21.Google Scholar
Sheline, YI, Pieper, CF, Barch, DM, Welsh-Boehmer, K, Mckinstry, RC, Macfall, JR, D'Angelo, G, Garcia, KS, Gersing, K and Wilkins, C (2010) Support for the vascular depression hypothesis in late-life depression: results of a 2-site, prospective, antidepressant treatment trial. Archives of General Psychiatry 67, 277–285.Google Scholar
Sneed, JR and Culang-Reinlieb, ME (2011) The vascular depression hypothesis: an update. The American Journal of Geriatric Psychiatry 19, 99.Google Scholar
Sneed, JR, Culang-Reinlieb, ME, Brickman, AM, Gunning-Dixon, FM, Johnert, L, Garcon, E and Roose, SP (2011) MRI signal hyperintensities and failure to remit following antidepressant treatment. Journal of Affective Disorders 135, 315–320.Google Scholar
Spreen, O and Bennett, D 1969 Neurosensory Centre Comprehensive Examination for Aphasia Manual (NCCEA). Victoria: University of Victoria.Google Scholar
Taylor, WD, Aizenstein, HJ and Alexopoulos, GS (2013) The vascular depression hypothesis: mechanisms linking vascular disease with depression. Molecular Psychiatry 18, 963–974.Google Scholar
Valkanova, V and Ebmeier, KP (2013) Vascular risk factors and depression in later life: a systematic review and meta-analysis. Biological Psychiatry 73, 406–413.Google Scholar
Van Agtmaal, MJ, Houben, AJ, Pouwer, F, Stehouwer, CD and Schram, MT (2017) Association of microvascular dysfunction with late-life depression: a systematic review and meta-analysis. JAMA Psychiatry 74, 729–739.Google Scholar
Van Der Kooy, K, Van Hout, H, Marwijk, H, Marten, H, Stehouwer, C and Beekman, A (2007) Depression and the risk for cardiovascular diseases: systematic review and meta analysis. International Journal of Geriatric Psychiatry 22, 613–626.Google Scholar
Van Sloten, TT, Sigurdsson, S, Van Buchem, MA, Phillips, CL, Jonsson, PV, Ding, J, Schram, MT, Harris, TB, Gudnason, V and Launer, LJ (2015) Cerebral small vessel disease and association with higher incidence of depressive symptoms in a general elderly population: the AGES-Reykjavik Study. American Journal of Psychiatry 172, 570–578.Google Scholar
Van Uden, IW, Van Der Holst, HM, Van Leijsen, EM, Tuladhar, AM, Van Norden, AG, De Laat, KF, Claassen, JA, Van Dijk, EJ, Kessels, RP and Richard, E (2016) Late-onset depressive symptoms increase the risk of dementia in small vessel disease. Neurology 87, 1102–1109.Google Scholar
Vemuri, P, Lesnick, TG, Przybelski, SA, Knopman, DS, Preboske, GM, Kantarci, K, Raman, MR, Machulda, MM, Mielke, MM and Lowe, VJ (2015) Vascular and amyloid pathologies are independent predictors of cognitive decline in normal elderly. Brain 138, 761–771.Google Scholar
Verdelho, A, Madureira, S, Moleiro, C, Ferro, JM, T O'Brien, J, Poggesi, A, Pantoni, L, Fazekas, F, Scheltens, P and Waldemar, G (2013) Depressive symptoms predict cognitive decline and dementia in older people independently of cerebral white matter changes: the LADIS study. Journal of Neurology, Neurosurgery & Psychiatry 84, 1250–1254.Google Scholar
Vermeer, SE, Prins, ND, Den Heijer, T, Hofman, A, Koudstaal, PJ and Breteler, MM (2003) Silent brain infarcts and the risk of dementia and cognitive decline. New England Journal of Medicine 348, 1215–1222.Google Scholar
Volkert, J, Schulz, H, Härter, M, Wlodarczyk, O and Andreas, S (2013) The prevalence of mental disorders in older people in Western countries – a meta-analysis. Ageing Research Reviews 12, 339–353.Google Scholar
Wang, L, Leonards, CO, Sterzer, P and Ebinger, M (2014) White matter lesions and depression: a systematic review and meta-analysis. Journal of Psychiatric Research 56, 56–64.Google Scholar
Wechsler, D 1981 WAIS-R Manual. New York: The Psychological Corporation.Google Scholar
Wechsler, D 1997 Wechsler Adult Intelligence Scale-III. San Antonio: The Psychological Corporation.Google Scholar
Weintraub, S, Salmon, D, Mercaldo, N, Ferris, S, Graff-Radford, NR, Chui, H, Cummings, J, Decarli, C, Foster, NL and Galasko, D (2009) The Alzheimer's disease centers’ uniform data set (UDS): the neuropsychological test battery. Alzheimer Disease and Associated Disorders 23, 91.Google Scholar
Wen, W, Sachdev, PS, Li, JJ, Chen, X and Anstey, KJ (2009) White matter hyperintensities in the forties: their prevalence and topography in an epidemiological sample aged 44–48. Human Brain Mapping 30, 1155–1167.Google Scholar
Whyte, EM and Mulsant, BH (2002) Post stroke depression: epidemiology, pathophysiology, and biological treatment. Biological Psychiatry 52, 253–264.Google Scholar
Yesavage, JA, Brink, T, Rose, TL, Lum, O, Huang, V, Adey, M and Leirer, VO (1983) Development and validation of a geriatric depression screening scale: a preliminary report. Journal of Psychiatric Research 17, 37–49.Google Scholar