title: Age of major depression onset, depressive symptoms, and risk for subsequent dementia: results of the German study on Ageing, Cognition, and Dementia in Primary Care Patients (AgeCoDe).
abstract: BACKGROUND
  Whether late-onset depression is a risk factor for or a prodrome of dementia remains unclear. We investigated the impact of depressive symptoms and early- v. late-onset depression on subsequent dementia in a cohort of elderly general-practitioner patients (n = 2663, mean age = 81.2 years).
  
  
  METHODS
  Risk for subsequent dementia was estimated over three follow-ups (each 18 months apart) depending on history of depression, particularly age of depression onset, and current depressive symptoms using proportional hazard models. We also examined the additive prediction of incident dementia by depression beyond cognitive impairment.
  
  
  RESULTS
  An increase of dementia risk for higher age cut-offs of late-onset depression was found. In analyses controlling for age, sex, education, and apolipoprotein E4 genotype, we found that very late-onset depression (aged ≥ 70 years) and current depressive symptoms separately predicted all-cause dementia. Combined very late-onset depression with current depressive symptoms was specifically predictive for later Alzheimer's disease (AD; adjusted hazard ratio 5.48, 95% confidence interval 2.41-12.46, p < 0.001). This association was still significant after controlling for cognitive measures, but further analyses suggested that it was mediated by subjective memory impairment with worries.
  
  
  CONCLUSIONS
  Depression might be a prodrome of AD but not of dementia of other aetiology as very late-onset depression in combination with current depressive symptoms, possibly emerging as a consequence of subjectively perceived worrisome cognitive deterioration, was most predictive. As depression parameters and subjective memory impairment predicted AD independently of objective cognition, clinicians should take this into account.
authors.affiliation: Department of Psychiatry, University of Bonn, Germany. Kathrin.Heser@ukb.uni-bonn.de
authors.forename: K
authors.initials: K
authors.lastname: Heser
authors.forename: F
authors.initials: F
authors.lastname: Tebarth
authors.forename: B
authors.initials: B
authors.lastname: Wiese
authors.forename: M
authors.initials: M
authors.lastname: Eisele
authors.forename: H
authors.initials: H
authors.lastname: Bickel
authors.forename: M
authors.initials: M
authors.lastname: Köhler
authors.forename: E
authors.initials: E
authors.lastname: Mösch
authors.forename: S
authors.initials: S
authors.lastname: Weyerer
authors.forename: J
authors.initials: J
authors.lastname: Werle
authors.forename: H-H
authors.initials: HH
authors.lastname: König
authors.forename: H
authors.initials: H
authors.lastname: Leicht
authors.forename: M
authors.initials: M
authors.lastname: Pentzek
authors.forename: A
authors.initials: A
authors.lastname: Fuchs
authors.forename: S G
authors.initials: SG
authors.lastname: Riedel-Heller
authors.forename: M
authors.initials: M
authors.lastname: Luppa
authors.forename: J
authors.initials: J
authors.lastname: Prokein
authors.forename: M
authors.initials: M
authors.lastname: Scherer
authors.forename: W
authors.initials: W
authors.lastname: Maier
authors.forename: M
authors.initials: M
authors.lastname: Wagner
mesh_terms: D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology*; D000544:Alzheimer Disease / Q000453:epidemiology* / Q000209:etiology; D003072:Cognition Disorders / Q000453:epidemiology; D003704:Dementia / Q000453:epidemiology* / Q000209:etiology; D003863:Depression / Q000453:epidemiology*; D003865:Major Depressive Disorder / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D012306:Risk