Association of Depressed Mood and Mortality in Older Adults With and Without Cognitive Impairment in a Prospective Naturalistic Study

Abstract

Objective: The authors examined predictors of mortality in individuals age 50 or older with or without cognitive impairment in a 12-year prospective naturalistic study of subcortical ischemic vascular disease focusing on symptoms of depressed mood, apathy, anhedonia, or anergia. Method: A total of 498 participants were recruited from the community and from memory clinics into a multicenter longitudinal study of subcortical ischemic vascular disease. For baseline cognitive status, 36% of participants were assessed as cognitively intact, 31% as cognitively impaired, and 33% as demented. All participants underwent a research protocol MRI, and 41% were classified as having subcortical lacunes. Depressed mood, anhedonia, anergia, and apathy were assessed at baseline using a structured behavioral assessment. Cox regression models were used to investigate the associations between neuropsychiatric symptoms and mortality, controlling for age, gender, race, education level, cognitive status, presence of vascular lacunes, and vascular risk factors. Results: Of 498 participants, 175 (35%) died over the follow-up period, with a median survival time of 5.6 years. In the multivariate analyses, cognitive impairment, age, male gender, depressed mood, and the presence of lacunes predicted higher mortality. Participants with both lacunes and depressed mood had the shortest survival among all cognitive groups. The mortality hazard ratio for participants with depressed mood was 2.2 (95% CI=1.5–3.2) after adjustment for cognitive status, age, gender, education level, race, lacunes, and all vascular conditions. Conclusions: These findings suggest the importance of detecting depressed mood in individuals with cerebrovascular disease and of developing more aggressive treatment and preventive interventions for this vulnerable population.

Survival in Subcortical Vascular Dementia: Predictors and Comparison to Probable Alzheimer's Disease in a Tertiary Memory Clinic Population

“…Unlike in our study there was no difference between survival times in SVaD patients with and without hypertension. The SVaD patients without hypertension from the CREDOS registry had less other vascular risk factors such as DM, dyslipidemia and obesity, and also had less depression, all of which can lead to better prognosis [6]. …”

“…Lastly, further understanding of factors associated with poor survival in SVaD will help clinicians pay more attention to these factors in the treatment of SVaD. To our knowledge, however, few studies have evaluated survival in patients with SVaD [6,7]. …”

Mini-Mental State Examination as a Predictor of Mortality among Older People Referred to Secondary Mental Healthcare

“…Some research has suggested that depression is an independent risk factor for mortality in people without dementia [10], [22], although others have not found this [16], and the diagnosis of depressive disorder itself is recognised to be associated with elevated mortality risk particularly in older people [23].…”

Vascular depression and frailty: a compound threat to longevity among older-old women

“…While results have been mixed for both neuroradiological (Rainer et al, 2006) and clinical studies (Lyness et al, 1999), both approaches generally support vascular depression theory. Of particular relevance to this synthesis, elders with high CVB and depression have much higher mortality rates than their healthier counterparts (Lavretsky et al, 2010). …”