title: Comorbidity of Cognitive Impairment and Late-Life Depression Increase Mortality: Results From a Cohort of Community-Dwelling Elderly Individuals in Rural Greece.
abstract: To investigate the association of cognitive impairment (COGI) and depression with all-cause mortality and cardiovascular-specific mortality among community-dwelling elderly individuals in rural Greece.
  
  
  
  Cognition and depressive symptomatology of 676 Velestino town residents aged ≥60 years were assessed using Mini-Mental State Examination (MMSE) and Geriatric Depression Scale (GDS), respectively. Eight-year all-cause mortality and cardiovascular mortality were explored by multivariate Cox regression models controlling for major confounders.
  
  
  
  Two hundred and one patients died during follow-up. Cognitive impairment (MMSE ≤ 23) was independently associated with all-cause mortality (hazard ratio [HR]: 1.57, 95% confidence interval [CI]: 1.13-2.18) and cardiovascular mortality (HR: 1.57, 95%CI: 1.03-2.41). Moderate to severe depression (GDS > 10) was significantly associated only with a 51% increase in all-cause mortality. A male-specific association was noted for moderate to severe depression, whereas the effect of COGI was limited to females. Noteworthy, COGI and depression comorbidity, rather than their sole presence, increased all-cause mortality and cardiovascular mortality by 66% and 72%, respectively. The mortality effect of COGI was augmented among patients with depression and of depression among patients with COGI.
  
  
  
  COGI and depression, 2 entities often coexisting among elderly individuals, appear to increase all-cause mortality and cardiovascular mortality. Gender-specific modes may prevail but their comorbidity should be carefully assessed, as it seems to represent an independent index of increased frailty, which eventually shortens life expectancy.
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece.
authors.forename: Marios K
authors.initials: MK
authors.lastname: Georgakis
authors.affiliation: Department of Neuroscience, Psychiatry, Uppsala University, Uppsala University Hospital, Athens, Greece.
authors.forename: Fotios C
authors.initials: FC
authors.lastname: Papadopoulos
authors.affiliation: Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Greece.
authors.forename: Athanasios D
authors.initials: AD
authors.lastname: Protogerou
authors.affiliation: Health Centre of Velestino, Ahillopouleio General Hospital of Volos, Greece.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Pagonari
authors.affiliation: Health Centre of Velestino, Ahillopouleio General Hospital of Volos, Greece.
authors.forename: Fani
authors.initials: F
authors.lastname: Sarigianni
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece.
authors.forename: Stylianos-Iason
authors.initials: SI
authors.lastname: Biniaris-Georgallis
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece.
authors.forename: Eleni Ι
authors.initials: EΙ
authors.lastname: Kalogirou
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Thomopoulos
authors.affiliation: First Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Greece.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Kapaki
authors.affiliation: First Department of Psychiatry, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Greece.
authors.forename: Charalampos
authors.initials: C
authors.lastname: Papageorgiou
authors.affiliation: Second Department of Neurology, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, Greece.
authors.forename: Socratis G
authors.initials: SG
authors.lastname: Papageorgiou
authors.affiliation: First Department of Cardiology, Hippokrateion Hospital, Medical School, National and Kapodistrian University of Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tousoulis
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece epetrid@med.uoa.gr.
authors.forename: Eleni Th
authors.initials: ET
authors.lastname: Petridou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition; D060825:Cognitive Dysfunction / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology* / Q000523:psychology; D003865:Major Depressive Disorder / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006115:Greece; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009483:Neuropsychological Tests; D016016:Proportional Hazards Models; D012424:Rural Population
keywords: cognitive impairment; dementia; depression; elderly; mortality; survival