Key result
Depressive symptoms increased the risk of all-cause dementia in older adults with small vessel disease (HR 2.7; 95% CI 1.4-5.2), driven primarily by late-onset symptoms.
Why the study?
Do depressive symptoms increase the risk of all-cause dementia in older adults with small vessel disease?
Cohort (n=503)
Do depressive symptoms increase the risk of all-cause dementia in older adults with small vessel disease?
Hazard Ratio: 2.7 (95% CI 1.4–5.2)
Late-onset depressive symptoms significantly increase the risk of all-cause dementia in patients with small vessel disease, particularly in those with high baseline cognitive performance.
Late-onset DS was associated with higher dementia risk in SVD, especially with preserved cognition; leaves open whether monitoring alters outcomes.
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.
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Uden et al. (2016) conducted a cohort in small vessel disease (n=503). depressive symptoms vs. no depressive symptoms was evaluated on all-cause dementia (HR 2.7, 95% CI 1.4-5.2). Depressive symptoms increased the risk of all-cause dementia in older adults with small vessel disease (HR 2.7; 95% CI 1.4-5.2), driven primarily by late-onset symptoms.
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