Depression as a Mediator of the Association Between Wealth Status and Risk of Cognitive Impairment and Dementia: A Longitudinal Population-Based Cohort Study

Abstract

Background: Wealth and income are potential modifiable risk factors for dementia, but whether wealth status, which is composed of a combination of debt and poverty, and assessed by wealth and income, is associated with cognitive impairment among elderly adults remains unknown. Objective: To examine the associations of different combinations of debt and poverty with the incidence of dementia and cognitive impairment without dementia (CIND) and to evaluate the mediating role of depression in these relationships. Methods: We included 15,565 participants aged 51 years or older from the Health and Retirement Study (1992–2012) who were free of CIND and dementia at baseline. Dementia and CIND were assessed using either the modified Telephone Interview for Cognitive Status (mTICS) or a proxy assessment. Cox models with time-dependent covariates and mediation analysis were used. Results: During a median of 14.4 years of follow-up, 4,484 participants experienced CIND and 1,774 were diagnosed with dementia. Both debt and poverty were independently associated with increased dementia and CIND risks, and the risks were augmented when both debt and poverty were present together (the hazard ratios [95% confidence intervals] were 1.35 [1.08–1.70] and 1.96 [1.48–2.60] for CIND and dementia, respectively). The associations between different wealth statuses and cognition were partially (mediation ratio range: 11.8–29.7%) mediated by depression. Conclusion: Debt and poverty were associated with an increased risk of dementia and CIND, and these associations were partially mediated by depression. Alleviating poverty and debt may be effective for improving mental health and therefore curbing the risk of cognitive impairment and dementia.

Social and behavioral risk factors associated with cognitive impairment among the middle-aged and elderly Russian population

“…Полученные в настоящем исследовании ассоциации между низким достатком и нарушениями КФ, по мнению Zhou R, et al, которые получили аналогичные результаты, могут быть связаны со стрессом и депрессией, вызванными долгами и бедностью. Авторы делают заключение, что уменьшение бедности и долгов может оказаться эффективным для улучшения психического здоровья и, следовательно, снижения риска когнитивных нарушений и деменции [16].…”

“…Полученные результаты могут быть связаны с тем, что наличие когнитивных нарушений препятствует дальнейшей трудовой деятельности, в результате участник вынужден уволиться [17]. В то же время, потеря работы может приводить к снижению социальной активности, стрессу, депрессии, которые косвенно способствуют развитию когнитивных нарушений [16,17].…”

“…Саранск; 15 ГБУЗ РМ "Мордовская республиканская центральная клиническая больница". Саранск; 16 ГБУ РС (Я) "Республиканский центр общественного здоровья и медицинской профилактики". Якутск; 17 ФГАОУ ВО "Северо-Восточный федеральный университет им.…”

“…14 , Esina M. V. 14 , Kunyaeva T. A. 14,15 , Nikitina A. M. 16 , Savvina N. V. 17 , Spiridonova Yu. E. 16 , Naumova E. A.…”

“…14,15 , Nikitina A. M. 16 , Savvina N. V. 17 , Spiridonova Yu. E. 16 , Naumova E. A. 18 , Keskinov A.…”