title: Depressive symptoms predict cognitive decline and dementia in older people independently of cerebral white matter changes: the LADIS study.
abstract: OBJECTIVE
  Depressive symptoms (DS) have been associated with increased risk of cognitive decline. Our aim was to evaluate the longitudinal influence of DS on cognition in independent older people, accounting for the severity of white matter changes (WMC).
  
  
  METHODS
  The LADIS (Leukoaraiosis And DISability in the elderly) prospective study evaluated the impact of WMC on the transition of independent older subjects into disability. Subjects were evaluated annually over a 3 year period with a comprehensive clinical and neuropsychological evaluation. Previous episodes of depression and current DS were assessed during each interview. Severity of DS was assessed using the self-rated 15 item Geriatric Depression Scale. A neuropsychological battery and clinical criteria for cognitive impairments were applied in all clinical visits, and cognitive compound measures were made based on neuropsychological results. MRI was performed at baseline and at year 3.
  
  
  RESULTS
  639 subjects were included (74.1 ± 5 years old, 55% women, 9.6 ± 3.8 years of schooling). Dementia was diagnosed in 90 patients and cognitive impairment not dementia in 147 patients at the last clinical evaluation. DS were an independent predictor of cognitive impairment (dementia and not dementia) during follow-up, independent of the effect of the severity of WMC, medial temporal lobe atrophy, age, education or global cognitive function at baseline.
  
  
  CONCLUSIONS
  DS are associated with an increase risk of cognitive decline, independent of the effect of WMC, probably due to an additive or synergistic effect. In this context, DS probably represent a subtle ongoing organic dysfunction.
authors.affiliation: Department of Neurociences, University of Lisbon, Santa Maria Hospital, , Lisbon, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Verdelho
authors.forename: Sofia
authors.initials: S
authors.lastname: Madureira
authors.forename: Carla
authors.initials: C
authors.lastname: Moleiro
authors.forename: José M
authors.initials: JM
authors.lastname: Ferro
authors.forename: John T
authors.initials: JT
authors.lastname: O'Brien
authors.forename: Anna
authors.initials: A
authors.lastname: Poggesi
authors.forename: Leonardo
authors.initials: L
authors.lastname: Pantoni
authors.forename: Franz
authors.initials: F
authors.lastname: Fazekas
authors.forename: Philip
authors.initials: P
authors.lastname: Scheltens
authors.forename: Gunhild
authors.initials: G
authors.lastname: Waldemar
authors.forename: Anders
authors.initials: A
authors.lastname: Wallin
authors.forename: Timo
authors.initials: T
authors.lastname: Erkinjuntti
authors.forename: Domenico
authors.initials: D
authors.lastname: Inzitari
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D000818:Animals; D001921:Brain / Q000473:pathology; D060825:Cognitive Dysfunction / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D018450:Disease Progression; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D011594:Psychometrics; D018570:Risk Assessment; D014912:White Muscle Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology
keywords: Cerebrovascular Disease; Cognition; Dementia; Depression