title: Dysthymia and depression increase risk of dementia and mortality among older veterans.
abstract: OBJECTIVE
  To determine whether less severe depression spectrum diagnoses such as dysthymia, as well as depression, are associated with risk of developing dementia and mortality in a "real-world" setting.
  
  
  METHODS
  Retrospective cohort study conducted using the Department of Veterans Affairs (VA) National Patient Care Database (1997-2007).
  
  
  METHODS
  VA medical centers in the United States.
  
  
  METHODS
  A total of 281,540 veterans aged 55 years and older without dementia at study baseline (1997-2000).
  
  
  METHODS
  Depression status and incident dementia were ascertained from International Classification of Diseases, Ninth Revision codes during study baseline (1997-2000) and follow-up (2001-2007), respectively. Mortality was ascertained by time of death dates in the VA Vital Status File.
  
  
  RESULTS
  Ten percent of veterans had baseline diagnosis of depression and nearly 1% had dysthymia. The unadjusted incidence of dementia was 11.2% in veterans with depression, 10.2% with dysthymia and 6.4% with neither. After adjusting for demographics and comorbidities, patients diagnosed with dysthymia or depression were twice as likely to develop incident dementia compared with those with no dysthymia/depression (adjusted dysthymia hazard ratio [HR]: 1.96, 95% confidence interval [CI]: 1.71-2.25; and depression HR: 2.18, 95% CI: 2.08-2.28). Dysthymia and depression also were associated with increased risk of death (31.6% dysthymia and 32.9% depression versus 28.5% neither; adjusted dysthymia HR: 1.41, 95% CI: 1.31-1.53; and depression HR: 1.47, 95% CI: 1.43-1.51).
  
  
  CONCLUSIONS
  Findings suggest that older adults with dysthymia or depression need to be monitored closely for adverse outcomes. Future studies should determine whether treatment of depression spectrum disorders may reduce risk of these outcomes.
authors: Departments of Psychiatry, University of California, San Francisco, USA. Amy.Byers@ucsf.edu
authors: Amy L
authors: AL
authors: Byers
authors: Kenneth E
authors: KE
authors: Covinsky
authors: Deborah E
authors: DE
authors: Barnes
authors: Kristine
authors: K
authors: Yaffe
references: Epidemiology. 2009 Jul;20(4):555-61
references: 19367167
references: Arch Gen Psychiatry. 1997 Oct;54(10):915-22
references: 9337771
references: Am J Geriatr Psychiatry. 2010 Mar;18(3):204-11
references: 20224517
references: Alzheimers Dement. 2010 Jan;6(1):63-9
references: 20129320
references: J Neurol Sci. 2009 Aug 15;283(1-2):139-42
references: 19345960
references: Stroke. 2002 Jun;33(6):1636-44
references: 12053004
references: Aust N Z J Psychiatry. 2001 Dec;35(6):776-81
references: 11990888
references: J Gen Intern Med. 1998 Nov;13(11):746-52
references: 9824520
references: Lancet. 2005 Jun 4-10;365(9475):1961-70
references: 15936426
references: J Gerontol A Biol Sci Med Sci. 2003 Mar;58(3):249-65
references: 12634292
references: Am J Epidemiol. 2002 Sep 1;156(5):445-53
references: 12196314
references: Arch Intern Med. 1998 Oct 26;158(19):2129-35
references: 9801180
references: Ann Intern Med. 1999 Apr 6;130(7):563-9
references: 10189325
references: Am J Geriatr Psychiatry. 2010 Mar;18(3):189-92
references: 20173422
references: Mayo Clin Proc. 2003 Nov;78(11):1423-9
references: 14601704
references: Arch Gen Psychiatry. 2006 Feb;63(2):153-60
references: 16461857
references: J Gerontol A Biol Sci Med Sci. 2003 May;58(5):M461-7
references: 12730257
references: J Psychiatr Res. 2009 Jun;43(9):855-63
references: 19128810
references: Int J Geriatr Psychiatry. 2008 Jul;23(7):726-34
references: 18188869
references: Neurology. 2002 Aug 13;59(3):364-70
references: 12177369
references: BMC Med. 2010 Jan 11;8:4
references: 20064226
references: Am J Public Health. 2007 Dec;97(12):2193-8
references: 17971541
references: Am J Geriatr Psychiatry. 2010 Mar;18(3):212-20
references: 20224518
references: Arch Gen Psychiatry. 2010 May;67(5):489-96
references: 20439830
references: Am J Geriatr Psychiatry. 2003 Sep-Oct;11(5):561-7
references: 14506090
references: Arch Gerontol Geriatr. 2007;44 Suppl 1:23-33
references: 17317430
references: J Am Coll Cardiol. 2009 Apr 21;53(16):1440-7
references: 19371828
references: J Gerontol. 1989 Jul;44(4):S149-56
references: 2738318
references: Arch Gen Psychiatry. 1999 May;56(5):425-30
references: 10232297
references: Arch Gen Psychiatry. 2006 Mar;63(3):273-9
references: 16520432
references: Arch Intern Med. 2000 Jun 26;160(12):1761-8
references: 10871968
references: J Gerontol A Biol Sci Med Sci. 2001 Aug;56(8):M505-9
references: 11487603
references: Am J Alzheimers Dis Other Demen. 2005 Jan-Feb;20(1):21-6
references: 15751450
references: Am J Geriatr Psychiatry. 2009 Aug;17(8):653-63
references: 19634208
references: J Psychosom Res. 2002 Oct;53(4):897-902
references: 12377300
references: N Engl J Med. 2004 Jul 1;351(1):13-22
references: 15229303
references: J Am Geriatr Soc. 2003 Aug;51(8):1178-80
references: 12890087
references: Arch Gen Psychiatry. 2006 May;63(5):530-8
references: 16651510