title: Clinical-pathologic study of depressive symptoms and cognitive decline in old age.
abstract: OBJECTIVE
  To clarify the relationship between depressive symptoms and the clinical and neuropathologic manifestations of dementia.
  
  
  METHODS
  In a clinical-pathologic cohort study, 1,764 older persons without cognitive impairment at enrollment completed annual clinical evaluations for a mean of 7.8 years. The evaluations included assessment of depressive symptoms (10-item Center for Epidemiological Studies Depression Scale) and cognitive function (battery of 17 performance tests). A total of 582 individuals died during follow-up and underwent a uniform neuropathologic examination to quantify β-amyloid plaques and tau tangle density in multiple brain regions and identify neocortical Lewy bodies, hippocampal sclerosis, and gross and microscopic cerebral infarcts.
  
  
  RESULTS
  Level of depressive symptoms slightly increased during follow-up. Incident mild cognitive impairment (52.2%) was associated with higher level of depressive symptoms before the diagnosis but not with change in symptoms after the diagnosis; incident dementia (17.9%) was associated with higher symptom level before dementia onset and with more rapid decline in symptoms after dementia onset. None of the neuropathologic markers was related to level of depressive symptoms or change in symptoms over time. In a mixed-effects model adjusted for the neuropathologic markers, higher level of depressive symptoms averaged over evaluations was associated with more rapid global cognitive decline, accounting for 4.4% of the variability in decline not attributable to the neuropathologic markers. Depressive symptoms did not modify the association of the neuropathologic markers with cognitive decline.
  
  
  CONCLUSIONS
  In old age, depressive symptoms have an association with cognitive decline that is independent of the neuropathologic hallmarks of dementia.
authors: From the Rush Alzheimer's Disease Center (R.S.W., A.W.C., P.A.B., G.M.H., L.P.H., R.C.S., S.N., J.A.S., D.A.B.) and Departments of Behavioral Sciences (R.S.W., P.A.B.), Neurological Sciences (R.S.W., A.W.C., J.A.S., D.A.B.), Pathology (S.N., J.A.S.), and Family Medicine (R.C.S.), Rush University Medical Center, Chicago, IL; and Departments of Psychiatry and Neurology (S.E.A.), University of Pennsylvania, Philadelphia. rwilson@rush.edu.
authors: Robert S
authors: RS
authors: Wilson
authors: From the Rush Alzheimer's Disease Center (R.S.W., A.W.C., P.A.B., G.M.H., L.P.H., R.C.S., S.N., J.A.S., D.A.B.) and Departments of Behavioral Sciences (R.S.W., P.A.B.), Neurological Sciences (R.S.W., A.W.C., J.A.S., D.A.B.), Pathology (S.N., J.A.S.), and Family Medicine (R.C.S.), Rush University Medical Center, Chicago, IL; and Departments of Psychiatry and Neurology (S.E.A.), University of Pennsylvania, Philadelphia.
authors: Ana W
authors: AW
authors: Capuano
authors: From the Rush Alzheimer's Disease Center (R.S.W., A.W.C., P.A.B., G.M.H., L.P.H., R.C.S., S.N., J.A.S., D.A.B.) and Departments of Behavioral Sciences (R.S.W., P.A.B.), Neurological Sciences (R.S.W., A.W.C., J.A.S., D.A.B.), Pathology (S.N., J.A.S.), and Family Medicine (R.C.S.), Rush University Medical Center, Chicago, IL; and Departments of Psychiatry and Neurology (S.E.A.), University of Pennsylvania, Philadelphia.
authors: Patricia A
authors: PA
authors: Boyle
authors: From the Rush Alzheimer's Disease Center (R.S.W., A.W.C., P.A.B., G.M.H., L.P.H., R.C.S., S.N., J.A.S., D.A.B.) and Departments of Behavioral Sciences (R.S.W., P.A.B.), Neurological Sciences (R.S.W., A.W.C., J.A.S., D.A.B.), Pathology (S.N., J.A.S.), and Family Medicine (R.C.S.), Rush University Medical Center, Chicago, IL; and Departments of Psychiatry and Neurology (S.E.A.), University of Pennsylvania, Philadelphia.
authors: George M
authors: GM
authors: Hoganson
authors: From the Rush Alzheimer's Disease Center (R.S.W., A.W.C., P.A.B., G.M.H., L.P.H., R.C.S., S.N., J.A.S., D.A.B.) and Departments of Behavioral Sciences (R.S.W., P.A.B.), Neurological Sciences (R.S.W., A.W.C., J.A.S., D.A.B.), Pathology (S.N., J.A.S.), and Family Medicine (R.C.S.), Rush University Medical Center, Chicago, IL; and Departments of Psychiatry and Neurology (S.E.A.), University of Pennsylvania, Philadelphia.
authors: Loren P
authors: LP
authors: Hizel
authors: From the Rush Alzheimer's Disease Center (R.S.W., A.W.C., P.A.B., G.M.H., L.P.H., R.C.S., S.N., J.A.S., D.A.B.) and Departments of Behavioral Sciences (R.S.W., P.A.B.), Neurological Sciences (R.S.W., A.W.C., J.A.S., D.A.B.), Pathology (S.N., J.A.S.), and Family Medicine (R.C.S.), Rush University Medical Center, Chicago, IL; and Departments of Psychiatry and Neurology (S.E.A.), University of Pennsylvania, Philadelphia.
authors: Raj C
authors: RC
authors: Shah
authors: From the Rush Alzheimer's Disease Center (R.S.W., A.W.C., P.A.B., G.M.H., L.P.H., R.C.S., S.N., J.A.S., D.A.B.) and Departments of Behavioral Sciences (R.S.W., P.A.B.), Neurological Sciences (R.S.W., A.W.C., J.A.S., D.A.B.), Pathology (S.N., J.A.S.), and Family Medicine (R.C.S.), Rush University Medical Center, Chicago, IL; and Departments of Psychiatry and Neurology (S.E.A.), University of Pennsylvania, Philadelphia.
authors: Sukriti
authors: S
authors: Nag
authors: From the Rush Alzheimer's Disease Center (R.S.W., A.W.C., P.A.B., G.M.H., L.P.H., R.C.S., S.N., J.A.S., D.A.B.) and Departments of Behavioral Sciences (R.S.W., P.A.B.), Neurological Sciences (R.S.W., A.W.C., J.A.S., D.A.B.), Pathology (S.N., J.A.S.), and Family Medicine (R.C.S.), Rush University Medical Center, Chicago, IL; and Departments of Psychiatry and Neurology (S.E.A.), University of Pennsylvania, Philadelphia.
authors: Julie A
authors: JA
authors: Schneider
authors: From the Rush Alzheimer's Disease Center (R.S.W., A.W.C., P.A.B., G.M.H., L.P.H., R.C.S., S.N., J.A.S., D.A.B.) and Departments of Behavioral Sciences (R.S.W., P.A.B.), Neurological Sciences (R.S.W., A.W.C., J.A.S., D.A.B.), Pathology (S.N., J.A.S.), and Family Medicine (R.C.S.), Rush University Medical Center, Chicago, IL; and Departments of Psychiatry and Neurology (S.E.A.), University of Pennsylvania, Philadelphia.
authors: Steven E
authors: SE
authors: Arnold
authors: From the Rush Alzheimer's Disease Center (R.S.W., A.W.C., P.A.B., G.M.H., L.P.H., R.C.S., S.N., J.A.S., D.A.B.) and Departments of Behavioral Sciences (R.S.W., P.A.B.), Neurological Sciences (R.S.W., A.W.C., J.A.S., D.A.B.), Pathology (S.N., J.A.S.), and Family Medicine (R.C.S.), Rush University Medical Center, Chicago, IL; and Departments of Psychiatry and Neurology (S.E.A.), University of Pennsylvania, Philadelphia.
authors: David A
authors: DA
authors: Bennett
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D015331:Cohort Studies; D003704:Dementia / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D003863:Depression / Q000175:diagnosis / Q000209:etiology / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales