Depressive
Symptoms, Vascular Disease, and Mild Cognitive Impairment
Findings From the Cardiovascular Health Study
Deborah E. Barnes, PhD, MPH; George S.
Alexopoulos, MD; Oscar L. Lopez, MD; Jeff
D. Williamson, MD, MHS; Kristine Yaffe, MD
Arch Gen Psychiatry. 2006;63:273-279.
Context Depressive symptoms are common in
patients with dementia and may be associated with increased
risk of developing dementia. It has been hypothesized that
depressive symptoms and dementia may be attributable to
underlying vascular disease in some older persons.
Objectives To test the hypotheses (1) that
depressive symptoms are associated with increased risk of
developing mild cognitive impairment (MCI), a preclinical
state that often precedes dementia, and (2) that the
association between depressive symptoms and MCI is
attributable to underlying vascular disease.
Design Prospective, population-based,
longitudinal study.
Setting Random sample of adults 65 years or
older recruited from 4 US communities.
Participants Subjects were 2220 participants in
the Cardiovascular Health Study Cognition Study with high
cognitive function at baseline. Depressive symptoms were
measured at baseline using the 10-item Center for
Epidemiological Studies Depression Scale and were
classified as none (0-2 points), low (3-7 points), and
moderate or high ( 8 points). Vascular disease measures at baseline
included confirmed history of stroke, transient ischemic attack,
diabetes mellitus, or hypertension; carotid artery stenosis; ankle-arm
blood pressure index; and small or large infarcts or white
matter disease on cerebral magnetic resonance imaging. Mild
cognitive impairment was diagnosed after 6 years of follow-up based
on the consensus of a team of dementia experts using standard clinical
criteria.
Main Outcome Measure Diagnosis of MCI.
Results Depressive symptoms at baseline were
associated with increased risk of MCI (10.0%, 13.3%, and
19.7% for those with no, low, and moderate or high
depressive symptoms, respectively). This association was
diminished only slightly by adjustment for vascular disease
measures and demographics. Vascular disease measures also
were associated with increased risk of MCI, and these
associations were not diminished by adjustment for depressive symptoms
or demographics.
Conclusion Depressive symptoms were associated
with increased risk of MCI, and this association was
independent of underlying vascular disease.
Author Affiliations: Departments of Psychiatry (Drs
Barnes and
Yaffe), Neurology, and Epidemiology and Biostatistics (Dr Yaffe),
University of California, San Francisco; Department of Psychiatry,
Weill Medical College of Cornell University, Ithaca, NY (Dr
Alexopoulos); Departments of Neurology and Psychiatry, University of
Pittsburgh School of Medicine, Pittsburgh, Pa (Dr Lopez); and
Department of Medicine, Wake Forest University School of Medicine,
Winston-Salem, NC (Dr Williamson).
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