Skip to main content

Advertisement

SpringerLink
Log in

Depressive symptoms as predictor of dementia versus continuous cognitive decline: a 3-year prospective study

  • Original Investigation
  • Published:
European Journal of Ageing Aims and scope Submit manuscript

Abstract

Previous research including meta-analytic efforts supports the assumption that depression is able to predict dementia. The mechanisms of this association still remain to be revealed. Some possible explanations as, for example, the glucocorticoid cascade hypothesis assumes that there are underlying changes at the cortical level that drive the association. Therefore, gradual levels of depressive symptoms may also predict gradual change (decline) in cognitive performance. However, testing both of these predictions (depressive symptoms lead to dementia, and depressive symptoms lead to cognitive decline, respectively) with the same data has to our knowledge not been done in the previous literature. A sample of 562 participants aged 65 or older was examined four times over a period of 3 years. Study participants completed established measures of depression and cognitive functioning. Results based on Cox regression analysis showed that depressive symptoms were not able to predict the conversion to dementia during the following 3 years. Additionally, structural equation models as well as latent change score models did not support the assumption that depressive symptoms predict cognitive decline, measured as a continuous variable. We discuss several possibilities to explain these findings including the potential and possible limits of the glucocorticoid cascade hypothesis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Notes

  1. In the year 1995 Germany introduced a statutory long-term care insurance. People who are persistently dependent on the assistance of caregivers are eligible for benefits from this insurance. These participants were excluded from this study as people in need for nursing are often diagnosed with dementia and have lower life expectancies. Because this study was planned as a longitudinal study to investigate the precursors of and risk factors for dementia (see Bickel et al. 2006), this exclusion criterion seemed justifiable.

  2. We used CDR > .5 as cut-off because we did not expect many participants to develop moderate to severe dementia (CDR > 1) within this short measurement interval. Nevertheless, we repeated the analyses using a more strict criterion (classifying only participants with a CDR score of 2 or 3 as demented). The results obtained in this analysis did not change, the regression coefficient for the GDS score remained insignificant.

  3. Please note that the regression weights of MMSE scores and GDS scores have already been fixed to be one in the configural invariance model.

  4. Please note that this model was built under the assumption of strict factorial invariance for the latent depressive symptoms factor. Here, too, the level of factorial invariance across time was determined using the approach described above. Assessing factorial invariance for the cognition change factors was not appropriate given the different approach with which they were modeled. Therefore, factorial invariance was only determined for the latent depressive symptoms factor. The results of this analysis mirror the results for the SEM approach with one exception: the model under the assumption of strict factorial invariance did not fit significantly worse than the model under the assumption of strong factorial invariance, χdiff 2(6) = 8.58, p = .199. Therefore, the model used for the LCM approach was tested under the assumption of strict factorial invariance for the latent depressive symptoms factor.

  5. We thank an anonymous reviewer for this important observation.

References

  • Alexopoulos GS, Meyers BS, Young RC, Campbell S, Silbersweig D, Charlson M (1997) The ‘vascular depression’ hypothesis. Arch Gen Psychiatry 54(10):915–922

    Article  Google Scholar 

  • American Psychiatric Association (1995) Diagnostic and statistical manual of mental disorders: DSM-IV, international version with ICD-10 codes, Washington, DC

  • Bassuk SS, Berkman LF, Wypij D (1998) Depressive symptomatology and incident cognitive decline in an elderly community sample. Arch Gen Psychiatry 55(12):1073–1081

    Article  Google Scholar 

  • Becker JT, Chang Y-F, Lopez O, Dew MA, Sweet RA, Barnes D, Yaffe K, Young J, Kuller L, Reynolds CF III (2009) Depressed mood is not a risk factor for incident dementia in a community-based cohort. Am J Geriatr Psychiatry 17(8):653–663

    Article  Google Scholar 

  • Bickel H, Mösch E, Seigerschmidt E, Siemen M, Förstl H (2006) Prevalence and persistence of mild cognitive impairment among elderly patients in general hospitals. Dement Geriatr Cogn Disord 7:242–250

    Article  Google Scholar 

  • Binz U, Wendt G (1986) KUSTA. Kurz-Skala Stimmung/Aktivierung. Manual 2. Revidierte und erweiterte Auflage (Short scale mood/activation. Second edition). Beltz, Weinheim, Germany

  • Bremmer MA, Deeg DJH, Beekman ATF, Penninx BWJH, Lips P, Hoogendijk WJG (2007) Major depression in late life is associated with both hypo- and hypercortisolemia. Biol Psychiatry 62(5):479–486

    Article  Google Scholar 

  • Brunner R, Schaefer D, Hess K, Parzer P, Resch F, Schwab S (2006) Effect of high-dose cortisol on memory functions. In: Yehuda R (ed) Psychobiology of posttraumatic stress disorders: a decade of progress. Blackwell Publishing, Malden, pp 434–437

    Google Scholar 

  • Burke WJ, Rubin EH, Morris JC, Berg L (1988) Symptoms of “depression” in dementia of the Alzheimer type. Alz Dis Assoc Dis 2:356–362

    Article  Google Scholar 

  • Byers AL, Yaffe K (2011) Depression and risk of developing dementia. Nat Rev Neurol 7:323–331

    Article  Google Scholar 

  • Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383

    Article  Google Scholar 

  • Chen P, Ganguli M, Mulsant BH, DeKosky ST (1999) The temporal relationship between depressive symptoms and dementia: a community-based prospective study. Arch Gen Psychiatry 56(3):261–266

    Article  Google Scholar 

  • Comijs HC, Gerritsen L, Penninx BWJH, Bremmer MA, Deeg DJH, Geerlings MI (2010) The association between serum cortisol and cognitive decline in older persons. Am J Geriatr Psychiatry 18(1):42–50

    Article  Google Scholar 

  • Cui X, Lyness JM, Tu X, King DA, Caine ED (2007) Does depression precede or follow executive dysfunction? Outcomes in older primary care patients. Am J Psychiatry 164(8):1221–1228

    Article  Google Scholar 

  • De Nicola AF, Pietranera L, Beauquis J, Ferrini MG, Saravia FE (2009) Steroid protection in aging and age-associated diseases. Exp Gerontol 44:34–40

    Article  Google Scholar 

  • Dimitrov DM (2010) Testing for factorial invariance in the context of construct validation. Meas Eval Couns Dev 43(2):121–149

    Article  Google Scholar 

  • Dotson VM, Beydoun MA, Zonderman AB (2010) Recurrent depressive symptoms and the incidence of dementia and mild cognitive impairment. Neurology 75(1):27–34

    Article  Google Scholar 

  • Dufouil C, Fuhrer R, Dartigues J-F, Alpérovitch A (1996) Longitudinal analysis of the association between depressive symptomatology and cognitive deterioration. Am J Epidemiol 144:634–641

    Article  Google Scholar 

  • Erzigkeit H (2001) Kurztest zur Erfassung von Gedächtnis- und Aufmerksamkeitsstörungen: SKT; Form A; Form B; Form C; Form D; Form E. (Syndrom Short Test) Geromed, Erlangen, Germany

  • Folstein MF, Folstein SE, McHugh PR (1975) Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198

    Article  Google Scholar 

  • Forsell Y, Winblad B (1998) Major depression in a population of demented and nondemented older people: prevalence and correlates. J Am Geriatr Soc 46(1):27–30

    Google Scholar 

  • Gallagher P, Reid KS, Ferrier IN (2009) Neuropsychological functioning in health and mood disorder: modulation by glucocorticoids and their receptors. Psychoneuroendocrinology 34(Suppl 1):196–207

    Article  Google Scholar 

  • Ganguli M, Du Y, Dodge HH, Ratcliff GG, Chang C-Ch (2006) Depressive symptoms and cognitive decline in late life. A prospective epidemiological study. Arch Gen Psychiatry 63(2):153–160

    Google Scholar 

  • Geerlings MI, den Heijer T, Koudstaal PJ, Hofman A, Breteler MMB (2008) History of depression, depressive symptoms, and medial temporal lobe atrophy and the risk of Alzheimer disease. Neurology 70(15):1258–1264

    Article  Google Scholar 

  • Henderson AS (1990) Co-occurence of affective and cognitive symptoms: the epidemiologial evidence. Dementia 1:119–123

    Google Scholar 

  • Hughes C, Berg L, Danziger W, Coben L, Martin R (1982) A new clinical scale for the staging of dementia. Brit J Psychiatry 140(6):566–572

    Article  Google Scholar 

  • Irie F, Masaki KH, Petrovitch H, Abbott RD, Ross GW, Taaffe DR, Launer LJ, White LR (2008) Apolipoporotein E ε4 allele genotype and the effect of depressive symptoms on the risk of dementia in men. The Honolulu-Asia Aging Study. Arch Gen Psychiatry 65(8):906–912

    Google Scholar 

  • Jorm AF (2001) History of depression as a risk factor for dementia: an updated review. Aust NZ J Psychiatry 35(6):776–781

    Article  Google Scholar 

  • Kudielka BM, Buske-Kirschbaum A, Hellhammer DH, Kirschbaum C (2004) HPA axis responses to laboratory psychosocial stress in healthy elderly adults, younger adults, and children: impact of age and gender. Psychoneuroendocrinology 29(1):83–98

    Article  Google Scholar 

  • Lupien SJ, de Leon M, de Santi S, Convit A, Tarshish C, Nair NPV, Thakur M, McEwen BS, Hauger RL, Meaney MJ (1998) Cortisol levels during human aging predict hippocampal atrophy and memory deficits. Nat Neurosci 1(1):69–73

    Article  Google Scholar 

  • Lupien SJ, Maheu F, Tu M, Fiocco A, Schramek TE (2007) The effects of stress and stress hormones on human cognition: implications for the field of brain and cognition. Brain Cogn 65(3):209–237

    Article  Google Scholar 

  • McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan E (1984) Clinical diagnosis of Alzheimer’s disease: report of the NINCDS/ADRDA work group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 34:939–944

    Article  Google Scholar 

  • Meredith W (1993) Measurement invariance, factor analysis and factorial invariance. Psychometrika 58(4):525–543

    Article  Google Scholar 

  • Modrego PJ, Ferrández J (2004) Depression in patients with mild cognitive impairment increases the risk of developing dementia of Alzheimer type. Arch Neurol 61(8):1290–1293

    Article  Google Scholar 

  • Muthén LK, Muthén BO (2007) Mplus user’s guide, 5th edn. Muthén & Muthén, Los Angeles, CA

    Google Scholar 

  • Newcomer JW, Selke G, Melson AK, Hershey T, Craft S, Richards K, Alderson AL (1999) Decreased memory performance in healthy humans induced by stress-level cortisol treatment. Arch Gen Psychiatry 56(6):527–533

    Article  Google Scholar 

  • Ownby RL, Crocco E, Acevedo A, John V, Loewenstein D (2006) Depression and risk for Alzheimer disease: systematic review, meta-analysis, and metaregression analysis. Arch Gen Psychiatry 63(5):530–538

    Article  Google Scholar 

  • Penninx BWJH, Beekman ATF, Bandinelli S, Corsi AM, Bremmer M, Hoogendijk WJ, Guralnik JM, Ferrucci L (2007) Late-life depressive symptoms are associated with both hyperactivity and hypoactivity of the hypothalamo-pituitary-adrenal axis. Am J Geriatr Psychiatry 15(6):522–529

    Article  Google Scholar 

  • Prina A, Deeg D, Brayne C, Beekman A, Huisman M (2012) The association between depressive symptoms and non-psychiatric hospitalisation in older adults. Plos ONE 7(4). doi:10.1371/journal.pone.0034821

  • Radloff LS (1977) The CES-D scale: a self report depression scale for research in the general population. Appl Psychol Meas 1:385–401

    Article  Google Scholar 

  • Saczynski JS, Beiser A, Seshadri S, Auerbach S, Wolf PA, Au R (2010) Depressive symptoms and risk of dementia. The Framingham Heart Study. Neurology 75:35–41

    Article  Google Scholar 

  • Sapolsky RM, Krey LC, McEwen BS (1986) The neuroendocrinology of stress and aging: the glucocorticoid cascade hypothesis. Endocr Rev 7:284–301

    Article  Google Scholar 

  • Schumacker RE, Lomax RG (2010) A beginner’s guide to structural equation modeling. Routledge, New York

    Google Scholar 

  • Sheikh JI, Yesavage JA (1986) Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clin Gerontol 5(1–2):165–173

    Google Scholar 

  • Skoog I (1993) The prevalence of psychotic, depressive and anxiety syndromes in demented and non-demented 85-year-olds. Int J Geriatr Psychiatry 8(3):247–253

    Article  Google Scholar 

  • Steyer R, Eid M, Schwenkmezger P (1997) Modeling true intraindividual change: true change as a latent variable. Method Psychol Res 2(1):21–33

    Google Scholar 

  • Van den Kommer TN, Commijs HC, Aartsen MJ, Huisman, M, Deeg DJ, Beekman AT (2012) Depression and cognition: how do they interrelate in old age? Am J Geriatr Psychiatry (e-published)

  • Vinkers DJ, Gussekloo J, Stek ML, Westendorp RGJ, van der Mast RC (2004) Temporal relation between depression and cognitive impairment in old age: prospective population based study. Brit Med J 329:881–884

    Article  Google Scholar 

  • Wilson RS, Barnes LL, de Leon CFM, Aggerwal NT, Schneider JS, Bach J, Pilat J, Beckett LA, Arnold SE, Evans DA, Bennett DA (2002) Depressive symptoms, cognitive decline, and risk of AD in older persons. Neurology 59(364):370

    Google Scholar 

  • Wilson RS, Arnold SE, Beck TL, Bienias JL, Bennett DA (2008) Change in depressive symptoms during the prodromal phase of Alzheimer disease. Arch Gen Psychiatry 65(4):439–446

    Article  Google Scholar 

  • Zimprich D, Martin M, Kliegel M (2003) Subjective cognitive complaints, memory performance, and depressive affect in old age: a change-oriented approach. Int J Aging Hum Dev 57(4):339–366

    Article  Google Scholar 

Download references

Acknowledgments

This study was supported by Dr. Willmar Schwabe Arzneimittel, Karlsruhe, Germany. We are indebted to the hospital medical directors Prof. Dr. A. Schömig, Prof. Dr. M. Classen (Klinikum rechts der Isar, Fakultät für Medizin der Technischen Universität München), Prof. Dr. R. Heinrich (Städtisches Krankenhaus München-Neuperlach), Prof. Dr. K. Helmke, Prof. Dr. K.D. Hepp, Prof. Dr. W. Schepp (Städtisches Krankenhaus München-Bogenhausen) and their staff, whose cooperation made the investigation possible.

Author information

Authors and Affiliations

  1. Institute of Psychology, University of Heidelberg, Bergheimer Strasse 20, 69115, Heidelberg, Germany

    Andreas B. Neubauer & Hans-Werner Wahl

  2. Department of Psychiatry, Technical University of Munich, Munich, Germany

    Horst Bickel

Authors
  1. Andreas B. Neubauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hans-Werner Wahl
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Horst Bickel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hans-Werner Wahl.

Additional information

Responsible editor: D. J. H. Deeg.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Neubauer, A.B., Wahl, HW. & Bickel, H. Depressive symptoms as predictor of dementia versus continuous cognitive decline: a 3-year prospective study. Eur J Ageing 10, 37–48 (2013). https://doi.org/10.1007/s10433-012-0246-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10433-012-0246-4

Keywords

Search

Navigation