title: Variability in depressive symptoms predicts cognitive decline in age-related macular degeneration.
abstract: OBJECTIVE
  The measurement of affective symptoms in older persons who decline cognitively is uncertain. The authors investigated whether mood variability predicts dementia in patients with age-related macular degeneration (AMD).
  
  
  METHODS
  Three-year observational study after a clinical trial.
  
  
  METHODS
  Community follow-up of outpatients ascertained from retina clinics.
  
  
  METHODS
  One hundred sixty patients with AMD.
  
  
  METHODS
  Geriatric Depression Scale (GDS) administered every 2 weeks for 6 months to subjects; Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) administered to subjects' knowledgeable informants.
  
  
  RESULTS
  Twenty-three subjects (14.4%) declined cognitively. Age, education, baseline GDS score > or =5, and variability in GDS scores (i.e., fluctuations between adjacent time points) were associated with cognitive decline. For GDS variability, each 1 unit increase in the residual standard deviation (SD) of the GDS increased the risk for cognitive decline by 93% (IDR = 1.92; 95% CI [1.27-2.91]). Thus, subjects with a residual SD of 1 were nearly twice as likely to become demented as subjects with no variability in GDS scores. The risk for subjects with SDs of 2 increased more than threefold (IDR = 3.68; 95% CI [1.61-8.47]). A multiple regression analysis showed that GDS variability was a significant risk factor for dementia after controlling for significant covariates.
  
  
  CONCLUSIONS
  These data suggest a useful approach to conceptualizing and measuring depressive symptoms in older persons. Variability in self-reported mood may be an early sign of dementia and may offer new insights into the neurobiological mechanisms linking depression and cognition
authors: Department of Psychiatry and Neurology, Jefferson Medical College, Philadelphia, PA 19107, USA. barry.rovner@jefferson.edu
authors: Barry W
authors: BW
authors: Rovner
authors: Robin J
authors: RJ
authors: Casten
authors: Benjamin E
authors: BE
authors: Leiby
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D015928:Cognitive Behavioral Therapy / Q000379:methods; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008268:Macular Degeneration / Q000453:epidemiology / Q000523:psychology*; D008297:Male; D008403:Mass Screening; D008609:Mental Status Schedule; D010552:Personality Assessment / Q000706:statistics & numerical data; D010555:Personality Inventory / Q000706:statistics & numerical data; D011340:Problem Solving; D011594:Psychometrics; D018570:Risk Assessment