title: Depression, vascular factors, and risk of dementia in primary care: a retrospective cohort study.
abstract: OBJECTIVE
  To study the interaction between and timing effects of depression and vascular disorders on dementia risk.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Primary care practices in the south of the Netherlands.
  
  
  METHODS
  Individuals in primary care aged 50 to 100 followed for 13 years (N = 35,791).
  
  
  METHODS
  Medical diagnoses of incident depression, hypertension, obesity, type 2 diabetes mellitus, stroke, and dementia were extracted from a research database. Cox proportional hazards regression was used to test whether incident depression predicted dementia and its putative interactions with vascular factors.
  
  
  RESULTS
  In total, 1,680 participants developed dementia. Individuals with depression (n = 978) had a higher risk of dementia (adjusted hazard ratio (HR) = 2.03, 95% confidence interval (CI) = 1.56-2.64). Depression exerted most effect in participants with incident stroke (HR = 5.29, 95% CI = 2.52-11.14) or newly diagnosed hypertension (HR = 3.09, 95% CI = 1.54-6.20).
  
  
  CONCLUSIONS
  Depression in later life increases the risk of dementia. The effect is particularly high in individuals with depression and vascular disorders. Targeting late-onset depression in individuals with vascular disorders might lower dementia risk by preventing cerebrovascular changes.
authors.affiliation: Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Köhler
authors.forename: Frank
authors.initials: F
authors.lastname: Buntinx
authors.forename: Katie
authors.initials: K
authors.lastname: Palmer
authors.forename: Marjan
authors.initials: M
authors.lastname: van den Akker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003704:Dementia / Q000209:etiology*; D003863:Depression / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D011320:Primary Health Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications; D014652:Vascular Diseases / Q000150:complications*
keywords: dementia; depression; epidemiology; hypertension; stroke