title: Associations between Dementia Outcomes and Depressive Symptoms, Leisure Activities, and Social Support.
abstract: BACKGROUND
  Social relations and depressive symptoms are intertwined. They both predict subsequent dementia, but only few studies on the association between social life aspects and subsequent dementia exist.
  
  
  METHODS
  The risk of subsequent dementia was estimated over 2 follow-up assessments, each 18 months apart, depending on leisure activity, social support (general scale and the 3 factors emotional support, practical support, and social integration), and depressive symptoms, using proportional hazard models in a cohort of elderly patients (n = 2,300, with a mean age of 82.45 years) recruited for the study by their general practitioners.
  
  
  RESULTS
  Higher depressive symptoms and lower cognitive and physical activity were associated with an increased risk of subsequent all-cause dementia and Alzheimer's dementia (AD). While neither social engagement nor the general social support scale was associated with subsequent dementia, a higher level of social integration was associated with a lower dementia risk. In combined models, the results for activity variables remained similar, but the strength of the association between depressive symptoms and the subsequent risk of dementia decreased, and the association with social integration disappeared.
  
  
  CONCLUSIONS
  Depressive symptoms increased and activity variables decreased the risk of subsequent dementia; however, activity variables, namely cognitive and physical activity, partly mediated the effect of depressive symptoms on the subsequent risk of all-cause dementia and AD. In many cases, social support was not associated with a risk of subsequent dementia.
authors: Department of Psychiatry, University of Bonn, Bonn, Germany.
authors: Kathrin
authors: K
authors: Heser
authors: Department of Psychiatry, University of Bonn, Bonn, Germany ; German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.
authors: Michael
authors: M
authors: Wagner
authors: Working Group Medical Statistics and IT Infrastructure, Institute of General Practice, Hannover Medical School, Hannover, Germany.
authors: Birgitt
authors: B
authors: Wiese
authors: Working Group Medical Statistics and IT Infrastructure, Institute of General Practice, Hannover Medical School, Hannover, Germany.
authors: Jana
authors: J
authors: Prokein
authors: Department of Primary Medical Care, University Medical Centre, Hamburg-Eppendorf, Germany.
authors: Annette
authors: A
authors: Ernst
authors: Department of Medical Sociology and Health Economics, University Medical Centre, Hamburg-Eppendorf, Germany.
authors: Hans-Helmut
authors: HH
authors: König
authors: Department of Medical Sociology and Health Economics, University Medical Centre, Hamburg-Eppendorf, Germany.
authors: Christian
authors: C
authors: Brettschneider
authors: Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany.
authors: Steffi G
authors: SG
authors: Riedel-Heller
authors: Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany.
authors: Melanie
authors: M
authors: Luppa
authors: Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
authors: Siegfried
authors: S
authors: Weyerer
authors: Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
authors: Sandra
authors: S
authors: Eifflaender-Gorfer
authors: Department of Psychiatry, Technical University Munich, Munich, Germany.
authors: Horst
authors: H
authors: Bickel
authors: Department of Psychiatry, Technical University Munich, Munich, Germany.
authors: Edelgard
authors: E
authors: Mösch
authors: Institute of General Practice, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
authors: Michael
authors: M
authors: Pentzek
authors: Institute of General Practice, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
authors: Angela
authors: A
authors: Fuchs
authors: Department of Psychiatry, University of Bonn, Bonn, Germany ; German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.
authors: Wolfgang
authors: W
authors: Maier
authors: Department of Primary Medical Care, University Medical Centre, Hamburg-Eppendorf, Germany.
authors: Martin
authors: M
authors: Scherer
authors: Department of Primary Medical Care, University Medical Centre, Hamburg-Eppendorf, Germany.
authors: Marion
authors: M
authors: Eisele
keywords: Alzheimer's dementia; Cognitive activities; Dementia; Depressive symptoms; Emotional support; Physical activities; Practical support; Social engagement; Social support