title: Gender differences in the longitudinal associations of depressive symptoms and leisure-time physical activity with cognitive decline in ≥57year-old Taiwanese.
abstract: OBJECTIVE
  This study investigates the role of gender in the associations of long-term depressive symptoms and leisure-time physical activity (LTPA) with the risk of cognitive decline in elderly Taiwanese.
  
  
  METHODS
  We analyzed 3679 subjects (age ≥57) in the 2003 and 2007 datasets of the Taiwan Longitudinal Survey on Aging, of which data were collected via face-to-face interviews by trained interviewers. We excluded proxy respondents. Multivariable logistic regression analysis examined the associations of long-term depressive symptoms (increased symptoms: CES-D10 scores from <10 to ≥10; decreased symptoms: from ≥10 to <10) and LTPA (frequency, duration, and intensity) with cognitive decline (a decrease of two or more SPMSQ scores).
  
  
  RESULTS
  Women had significant higher percentages of cognitive impairment, compared to men, at the baseline (5.9 vs. 1.5%; χ(2)=51.24, p<0.001) and end-point (10.8 vs. 5.2%;χ(2)=39.5, p<0.001). Men with long-term depressive symptoms had 5.28 greater odds of cognitive decline (OR=5.28, 95%CI=2.84-9.82, p<0.001) and men with increased depressive symptoms had 2.09 greater odds (2.09, 1.24-3.51, p=0.006). No such association was observed in women. Men with consistently high LTPA had 65% (0.35, 0.19-0.65, p=0.001) and women with increased LTPA had 43% (0.57, 0.34-0.93, p=0.024) reduction in odds of developing cognitive decline.
  
  
  CONCLUSIONS
  We found gender differences in the longitudinal association between depressive symptoms and cognitive decline. Long-term LTPA may loosen the association between long-term depressive symptoms and cognitive decline. These findings are useful in the identification of vulnerable elderly in the Taiwanese population and public health interventions should focus on assisting their cognitive aging.
authors.affiliation: Department of Psychology, Asia University, Wu-feng, Taichung, Taiwan. Electronic address: Changs.research@gmail.com.
authors.forename: Shujen L
authors.initials: SL
authors.lastname: Chang
authors.affiliation: Department of Healthcare Administration, Asia University, Wu-feng, Taichung, Taiwan; Department of Health Services Management, School of Public Health, China Medical University, Taichung, Taiwan.
authors.forename: Alan C
authors.initials: AC
authors.lastname: Tsai
mesh_terms: D000368:Aged; D000375:Aging; D003072:Cognition Disorders / Q000503:physiopathology*; D003863:Depression / Q000523:psychology*; D015444:Exercise / Q000523:psychology*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D007899:Leisure Activities; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D013624:Taiwan
keywords: Cognitive decline; Depressive symptoms; Older adults; Physical activity; Taiwan