Depression as a risk factor for cognitive impairment in later life: the Health In Men cohort study.
BACKGROUND
Depression is an established risk factor for dementia in later life, but it is unclear if this relationship is causal. This study aimed to determine if clinically significant depressive symptoms are likely to be causally related to cognitive impairment in later life.


METHODS
Observational cohort study of 4568 men aged 70-89 years living in Perth, Western Australia, who were free of cognitive impairment at the beginning of follow-up. Current clinically significant depressive symptoms were defined by a score of 7 or more on the Geriatric Depression Scale 15 items. Past depression was ascertained via electronic medical records, by self-report or use of antidepressants. A score of 27 or less on the Telephone Interview for Cognitive Status modified or a recorded diagnosis of dementia in electronic medical records established the presence of cognitive impairment.


RESULTS
During the 5-year follow-up, 534 men developed cognitive impairment, 811 died and 1455 were lost. The presence of clinically significant depressive symptoms at study entry was associated with increased risk rate (RR) of cognitive impairment (RR = 2.59, 95% confidence interval: 95%CI = 1.57-4.27), death (RR = 5.07, 95%CI = 3.32-7.75) and loss to follow-up (RR = 2.03, 95%CI = 1.32-3.13). These associations remained statistically significant after adjustment for age, country of birth, education, smoking history, and prevalence hypertension, diabetes, coronary heart disease and stroke. History of past clinically significant depressive symptoms was not associated with incident cognitive impairment (RR = 1.09, 95%CI = 0.78-1.52).


CONCLUSIONS
The lack of association between past depression and cognitive impairment suggests that the link between depression and cognitive impairment is not causal and that the presence of clinically significant depressive symptoms in later life may herald the onset of cognitive impairment in at least some people.
School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia.|WA Centre for Health and Ageing, Centre for Medical Research, Perth, Australia.|Department of Psychiatry, Royal Perth Hospital, Perth, Australia.
Osvaldo P
OP
Almeida
School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.|Department of Neurology, Sir Charles Gairdner Hospital, Perth, Australia.
Graeme J
GJ
Hankey
School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.|Department of Diabetes and Endocrinology, Fremantle Hospital, Fremantle, Australia.
Bu B
BB
Yeap
Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia.|Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Australia.
Jonathan
J
Golledge
WA Centre for Health and Ageing, Centre for Medical Research, Perth, Australia.|School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.|Department of Geriatric Medicine, Royal Perth Hospital, Perth, Australia.
Leon
L
Flicker
D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000453:epidemiology / Q000523:psychology*; D015331:Cohort Studies; D003866:Depressive Disorder / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D008297:Male; D054526:Men's Health; D015995:Prevalence; D012307:Risk Factors; D014904:Western Australia / Q000453:epidemiology
cognitive impairment; dementia; depression; epidemiology; risk factors