title: The association of depression, cognitive impairment without dementia, and dementia with risk of ischemic stroke: a cohort study.
abstract: OBJECTIVE
  To determine if depression, cognitive impairment without dementia (CIND), and/or dementia are each independently associated with risk of ischemic stroke and to identify characteristics that could modify these associations.
  
  
  METHODS
  This retrospective-cohort study examined a population-based sample of 7031 Americans older than 50 years participating in the Health and Retirement Study (1998-2008) who consented to have their interviews linked to their Medicare claims. The eight-item Center for Epidemiologic Studies Depression Scale and/or International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) depression diagnoses were used to identify baseline depression. The Modified Telephone Interview for Cognitive Status and/or ICD-9-CM dementia diagnoses were used to identify baseline CIND or dementia. Hospitalizations for ischemic stroke were identified via ICD-9-CM diagnoses.
  
  
  RESULTS
  After adjusting for demographics, medical comorbidities, and health-risk behaviors, CIND alone (odds ratio [OR] = 1.37, 95% confidence interval [CI] = 1.11-1.69) and co-occurring depression and CIND (OR = 1.65, 95% CI = 1.24-2.18) were independently associated with increased odds of ischemic stroke. Depression alone was not associated with odds of ischemic stroke (OR = 1.11, 95% CI = 0.88-1.40) in unadjusted analyses. Neither dementia alone (OR = 1.09, 95% CI = 0.82-1.45) nor co-occurring depression and dementia (OR = 1.25, 95% CI = 0.89-1.76) were associated with odds of ischemic stroke after adjusting for demographics.
  
  
  CONCLUSIONS
  CIND and co-occurring depression and CIND are independently associated with increased risk of ischemic stroke. Individuals with co-occurring depression and CIND represent a high-risk group that may benefit from targeted interventions to prevent stroke.
authors: From the Department of Psychiatry and Behavioral Sciences (Davydow, Katon), University of Washington, Seattle, Washington; the Departments of Medicine (Levine, Langa) and Psychiatry (Zivin), and Institute for Social Research (Zivin, Langa), University of Michigan, Ann Arbor, Michigan; and the Ann Arbor Veterans Affairs Center for Clinical Management Research (Levine, Langa), Ann Arbor, Michigan.
authors: Dimitry S
authors: DS
authors: Davydow
authors: Deborah A
authors: DA
authors: Levine
authors: Kara
authors: K
authors: Zivin
authors: Wayne J
authors: WJ
authors: Katon
authors: Kenneth M
authors: KM
authors: Langa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D060825:Cognitive Dysfunction / Q000150:complications*; D015331:Cohort Studies; D003704:Dementia / Q000150:complications*; D003863:Depression / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology*; D014481:United States / Q000453:epidemiology
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