Older Adults With Depression at Higher Risk for Mild Cognitive Impairment
Older adults were at an increased risk for mild cognitive impairment if they were depressed within the last 3 years and had an increased level of severity.
The risk for mild cognitive impairment (MCI) is associated with clinical depression and depression severity in older adults, according to study data published in the Journal of Clinical Psychiatry.
Researchers abstracted patient data from the National Alzheimer's Coordinating Center data set, which collects medical records information from participating Alzheimer disease centers across the United States. Study patients who visited a participating care center between September 2005 and September 2017 and who had normal cognition and a history of clinical depression were followed until first diagnosis of MCI or dementia.
A total of 2655 study participants were followed for a mean duration of 41.8 months, in which 586 (22.1%) developed either MCI (n=509; 19.2%) or dementia (n=77; 2.9%). In the unadjusted survival analyses, cognitive decline was associated with age, sex, education, baseline cognition, and several "potentially modifiable risk factors," including: vascular risk factors, hearing impairment, vitamin B12 deficiency, active depression within the last 2 years, and increased severity of depression. Per adjusted survival analyses, the only variables significantly associated with a decreased risk for MCI or dementia included female sex (hazard ratio [HR], 0.72; 95% CI, 0.59-0.88), higher education (HR, 0.96; 95% CI, 0.93-0.99), and higher baseline cognition (HR, 0.87; 95% CI, 0.82-0.93). In addition, the variables significantly associated with increased risk included older age (HR, 1.07; 95% CI, 1.05-1.08), active depression within the last 2 years (HR, 1.41; 95% CI, 1.15-1.74), and increased severity of depression (HR, 1.05; 95% CI, 1.02-1.09).
Although this study highlighted many potential targets for intervention, further research is necessary to elucidate the precise relationship between certain risk factors and development of MCI. In particular, clinical management of depression should be explored as a means of mitigating MCI risk in older adults.
Gallagher D, Kiss A, Lanctot KL, Herrmann N. Toward prevention of mild cognitive impairment in older adults with depression: an observational study of potentially modifiable risk factors. J Clin Psychiatry. 2019;80(1):18m12331.