Clinical factors associated with progression to dementia in people with late-life depression: a cohort study of patients in secondary care

Abstract

ObjectivesDepression can be a prodromal feature or a risk factor for dementia. We aimed to investigate which clinical factors in patients with late-life depression are associated with a higher risk of developing dementia and a more rapid conversion.DesignRetrospective cohort study.SettingSouth London and Maudsley NHS Foundation Trust (SLaM) secondary mental healthcare services.ParticipantsThe SLaM Clinical Record Interactive Search was used to retrieve anonymised data on 3659 patients aged 65 years or older who had received a diagnosis of depression in mental health services and had been followed up for at least 3 months.Outcome measuresPredictors of development of incident dementia were investigated, including demographic factors, health status rated on the Health of the National Outcome scale for older people (HoNOS65+), depression recurrence and treatments including psychotropic drugs and cognitive behavioural therapy (CBT).ResultsIn total, 806 (22.0%) patients developed dementia over a mean follow-up time of 2.7 years. Significant predictors of receiving a dementia diagnosis in fully adjusted models and after accounting for multiple comparisons were older age (adjusted HR=1.04, 95% CI 1.03 to 1.06 per year difference from sample mean) and the HoNOS65+ subscale measuring cognitive problems (HR=4.72, 95% CI 3.67 to 6.06 for scores in the problematic range). Recurrent depressive disorder or past depression (HR=0.65, 95% CI 0.55 to 0.77) and the receipt of CBT (HR=0.73 95% CI 0.61 to 0.87) were associated with a lower dementia risk. Over time, hazards related to age increased and hazards related to cognitive problems decreased.ConclusionsIn older adults with depression, a higher risk of being subsequently diagnosed with dementia was predicted by higher age, new onset depression, severity of cognitive symptoms and not receiving CBT. Further exploration is needed to determine whether the latter risk factors are responsive to interventions.

Depression as a Risk Factor for Dementia and Alzheimer’s Disease

“…Thus, the onset of these symptoms in old ages can be understood as a prodromal factor, and in turn, the appearance of early depression can be understood as a risk factor for developing dementia and/or AD in both early and old ages [50,51].…”

Predictors of Changes in Cognitive Function in Older Korean Adults: The 2006–2018 Korean Longitudinal Study of Aging

“…Second, lower handgrip strength may represent an early sign of age-related cognitive decline [ 50 ] or overall health status including cognitive dysfunction and depression [ 51 ] in geriatric populations. Third, late-life depression itself or by interacting with frailty phenotypes such as UWL, physical inactivity, and lower handgrip strength may an impact on geriatric mental conditions including mild cognitive impairment and dementia [ 52 , 53 ]. Fourth, existing health conditions may accelerate cognitive decline with normal aging and thereby increase the risk for cognitive impairments and dementia [ 54 ].…”

Mood Disorders

“…Popular interventions used include animal therapy, cognitive stimulation, exercise and social interaction, massage therapy, reminiscence therapy, occupational therapy, multidisciplinary care, and environmental modification 48,50 . Data regarding treatment of major depression in patients with neurocognitive disorders are mixed 48,50,51 …”