title: Late-onset depressive symptoms increase the risk of dementia in small vessel disease.
abstract: OBJECTIVE
  We prospectively investigated the role of depressive symptoms (DS) on all-cause dementia in a population with small vessel disease (SVD), considering onset age of DS and cognitive performance.
  
  
  METHODS
  The RUN DMC study (Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Cohort) is a prospective cohort study among 503 older adults with SVD on MRI without dementia at baseline (2006), with a follow-up of 5 years (2012). Kaplan-Meier curves stratified for DS and dementia risk were compared using log-rank test. We calculated hazard ratios using Cox regression analyses.
  
  
  RESULTS
  Follow-up was available for 496 participants (mean baseline age 65.6 years [SD 8.8]; mean follow-up time 5.2 years). All-cause dementia developed in 41 participants. The 5.5-year dementia risk was higher in those with DS (hazard ratio 2.7, 95% confidence interval 1.4-5.2), independent of confounders. This was driven by those with late-onset DS. Five-year cumulative risk difference for dementia was higher in participants with depressive symptoms who had high baseline cognitive performance (no DS 0.0% vs DS 6.9%, log-rank p < 0.001) compared with those who had low cognitive performance at baseline.
  
  
  CONCLUSIONS
  Late-onset DS increases dementia risk, independent of SVD. Especially in those with relatively high cognitive performance, DS indicate a higher risk. In contrast to current practice, clinicians should monitor those with DS who also show relatively good cognitive test scores.
authors: From the Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Departments of Neurology (I.W.M.v.U., H.M.v.d.H., E.M.C.v.L., A.M.T., E.J.v.D., E.R., F.-E.d.L.), Geriatrics (J.A.H.R.C.), Medical Psychology (R.P.C.K.), and Psychiatry (I.T.), Nijmegen; Department of Neurology (A.G.W.v.N.), Amphia Ziekenhuis Breda; and Department of Neurology (K.F.d.L.), HagaZiekenhuis The Hague, the Netherlands.
authors: Ingeborg W M
authors: IW
authors: van Uden
authors: From the Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Departments of Neurology (I.W.M.v.U., H.M.v.d.H., E.M.C.v.L., A.M.T., E.J.v.D., E.R., F.-E.d.L.), Geriatrics (J.A.H.R.C.), Medical Psychology (R.P.C.K.), and Psychiatry (I.T.), Nijmegen; Department of Neurology (A.G.W.v.N.), Amphia Ziekenhuis Breda; and Department of Neurology (K.F.d.L.), HagaZiekenhuis The Hague, the Netherlands.
authors: Helena M
authors: HM
authors: van der Holst
authors: From the Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Departments of Neurology (I.W.M.v.U., H.M.v.d.H., E.M.C.v.L., A.M.T., E.J.v.D., E.R., F.-E.d.L.), Geriatrics (J.A.H.R.C.), Medical Psychology (R.P.C.K.), and Psychiatry (I.T.), Nijmegen; Department of Neurology (A.G.W.v.N.), Amphia Ziekenhuis Breda; and Department of Neurology (K.F.d.L.), HagaZiekenhuis The Hague, the Netherlands.
authors: Esther M C
authors: EM
authors: van Leijsen
authors: From the Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Departments of Neurology (I.W.M.v.U., H.M.v.d.H., E.M.C.v.L., A.M.T., E.J.v.D., E.R., F.-E.d.L.), Geriatrics (J.A.H.R.C.), Medical Psychology (R.P.C.K.), and Psychiatry (I.T.), Nijmegen; Department of Neurology (A.G.W.v.N.), Amphia Ziekenhuis Breda; and Department of Neurology (K.F.d.L.), HagaZiekenhuis The Hague, the Netherlands.
authors: Anil M
authors: AM
authors: Tuladhar
authors: From the Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Departments of Neurology (I.W.M.v.U., H.M.v.d.H., E.M.C.v.L., A.M.T., E.J.v.D., E.R., F.-E.d.L.), Geriatrics (J.A.H.R.C.), Medical Psychology (R.P.C.K.), and Psychiatry (I.T.), Nijmegen; Department of Neurology (A.G.W.v.N.), Amphia Ziekenhuis Breda; and Department of Neurology (K.F.d.L.), HagaZiekenhuis The Hague, the Netherlands.
authors: Anouk G W
authors: AG
authors: van Norden
authors: From the Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Departments of Neurology (I.W.M.v.U., H.M.v.d.H., E.M.C.v.L., A.M.T., E.J.v.D., E.R., F.-E.d.L.), Geriatrics (J.A.H.R.C.), Medical Psychology (R.P.C.K.), and Psychiatry (I.T.), Nijmegen; Department of Neurology (A.G.W.v.N.), Amphia Ziekenhuis Breda; and Department of Neurology (K.F.d.L.), HagaZiekenhuis The Hague, the Netherlands.
authors: Karlijn F
authors: KF
authors: de Laat
authors: From the Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Departments of Neurology (I.W.M.v.U., H.M.v.d.H., E.M.C.v.L., A.M.T., E.J.v.D., E.R., F.-E.d.L.), Geriatrics (J.A.H.R.C.), Medical Psychology (R.P.C.K.), and Psychiatry (I.T.), Nijmegen; Department of Neurology (A.G.W.v.N.), Amphia Ziekenhuis Breda; and Department of Neurology (K.F.d.L.), HagaZiekenhuis The Hague, the Netherlands.
authors: Jurgen A H R
authors: JA
authors: Claassen
authors: From the Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Departments of Neurology (I.W.M.v.U., H.M.v.d.H., E.M.C.v.L., A.M.T., E.J.v.D., E.R., F.-E.d.L.), Geriatrics (J.A.H.R.C.), Medical Psychology (R.P.C.K.), and Psychiatry (I.T.), Nijmegen; Department of Neurology (A.G.W.v.N.), Amphia Ziekenhuis Breda; and Department of Neurology (K.F.d.L.), HagaZiekenhuis The Hague, the Netherlands.
authors: Ewoud J
authors: EJ
authors: van Dijk
authors: From the Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Departments of Neurology (I.W.M.v.U., H.M.v.d.H., E.M.C.v.L., A.M.T., E.J.v.D., E.R., F.-E.d.L.), Geriatrics (J.A.H.R.C.), Medical Psychology (R.P.C.K.), and Psychiatry (I.T.), Nijmegen; Department of Neurology (A.G.W.v.N.), Amphia Ziekenhuis Breda; and Department of Neurology (K.F.d.L.), HagaZiekenhuis The Hague, the Netherlands.
authors: Roy P C
authors: RP
authors: Kessels
authors: From the Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Departments of Neurology (I.W.M.v.U., H.M.v.d.H., E.M.C.v.L., A.M.T., E.J.v.D., E.R., F.-E.d.L.), Geriatrics (J.A.H.R.C.), Medical Psychology (R.P.C.K.), and Psychiatry (I.T.), Nijmegen; Department of Neurology (A.G.W.v.N.), Amphia Ziekenhuis Breda; and Department of Neurology (K.F.d.L.), HagaZiekenhuis The Hague, the Netherlands.
authors: Edo
authors: E
authors: Richard
authors: From the Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Departments of Neurology (I.W.M.v.U., H.M.v.d.H., E.M.C.v.L., A.M.T., E.J.v.D., E.R., F.-E.d.L.), Geriatrics (J.A.H.R.C.), Medical Psychology (R.P.C.K.), and Psychiatry (I.T.), Nijmegen; Department of Neurology (A.G.W.v.N.), Amphia Ziekenhuis Breda; and Department of Neurology (K.F.d.L.), HagaZiekenhuis The Hague, the Netherlands.
authors: Indira
authors: I
authors: Tendolkar
authors: From the Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Departments of Neurology (I.W.M.v.U., H.M.v.d.H., E.M.C.v.L., A.M.T., E.J.v.D., E.R., F.-E.d.L.), Geriatrics (J.A.H.R.C.), Medical Psychology (R.P.C.K.), and Psychiatry (I.T.), Nijmegen; Department of Neurology (A.G.W.v.N.), Amphia Ziekenhuis Breda; and Department of Neurology (K.F.d.L.), HagaZiekenhuis The Hague, the Netherlands. frankerik.deleeuw@radboudumc.nl.
authors: Frank-Erik
authors: FE
authors: de Leeuw
mesh_terms: D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging; D059345:Cerebral Small Vessel Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000523:psychology; D003704:Dementia / Q000000981:diagnostic imaging / Q000453:epidemiology*; D003863:Depression / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk