Depressive symptoms, vascular disease, and mild cognitive impairment: findings from the Cardiovascular Health Study.
BACKGROUND
Depressive symptoms are common in patients with dementia and may be associated with increased risk of developing dementia. It has been hypothesized that depressive symptoms and dementia may be attributable to underlying vascular disease in some older persons.


OBJECTIVE
To test the hypotheses (1) that depressive symptoms are associated with increased risk of developing mild cognitive impairment (MCI), a preclinical state that often precedes dementia, and (2) that the association between depressive symptoms and MCI is attributable to underlying vascular disease.


METHODS
Prospective, population-based, longitudinal study.


METHODS
Random sample of adults 65 years or older recruited from 4 US communities.


METHODS
Subjects were 2220 participants in the Cardiovascular Health Study Cognition Study with high cognitive function at baseline. Depressive symptoms were measured at baseline using the 10-item Center for Epidemiological Studies Depression Scale and were classified as none (0-2 points), low (3-7 points), and moderate or high (>/=8 points). Vascular disease measures at baseline included confirmed history of stroke, transient ischemic attack, diabetes mellitus, or hypertension; carotid artery stenosis; ankle-arm blood pressure index; and small or large infarcts or white matter disease on cerebral magnetic resonance imaging. Mild cognitive impairment was diagnosed after 6 years of follow-up based on the consensus of a team of dementia experts using standard clinical criteria.


METHODS
Diagnosis of MCI.


RESULTS
Depressive symptoms at baseline were associated with increased risk of MCI (10.0%, 13.3%, and 19.7% for those with no, low, and moderate or high depressive symptoms, respectively). This association was diminished only slightly by adjustment for vascular disease measures and demographics. Vascular disease measures also were associated with increased risk of MCI, and these associations were not diminished by adjustment for depressive symptoms or demographics.


CONCLUSIONS
Depressive symptoms were associated with increased risk of MCI, and this association was independent of underlying vascular disease.
Barnes
Deborah E
DE
Department of Psychiatry, University of California, San Francisco 94121, USA. barnes@medicine.ucsf.edu
Alexopoulos
George S
GS
Lopez
Oscar L
OL
Williamson
Jeff D
JD
Yaffe
Kristine
K
D000368:Aged; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D003072:Cognition Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D015897:Comorbidity; D003704:Dementia / Q000453:epidemiology* / Q000209:etiology; D015140:Dementia, Vascular / Q000453:epidemiology / Q000209:etiology; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012494:Sampling Studies; D014652:Vascular Diseases / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*