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A Prospective Study

Kristine Yaffe, MD; Terri Blackwell, MA; Robert Gore, PhD; Laura Sands, PhD; Victor Reus, MD; Warren S. Browner, MD, MPH

Arch Gen Psychiatry. 1999;56:425-430.

Background  The association between depressive disorders and subsequent cognitive decline is controversial. We tested the hypothesis that elderly women (aged 65 years and older) without dementia but with depressive symptoms have worse cognitive function and greater cognitive decline than women with few or no symptoms.

Methods  As part of an ongoing prospective study, we evaluated 5781 elderly, mostly white, community-dwelling women. Women completed the Geriatric Depression Scale short form. Three cognitive tests—Trails B, Digit Symbol, and a modified Mini-Mental State Examination—were administered at baseline and approximately 4 years later. Baseline, follow-up, and change scores for the cognitive tests were analyzed by analysis of covariance and Kruskal-Wallis analysis; the odds of cognitive deterioration (3-point decline on the modified Mini-Mental State Examination) were determined by logistic regression.

Results  At baseline, 211 (3.6%) of the women had 6 or more depressive symptoms. Only 16 (7.6%) of these women were receiving antidepressant medication. Increasing symptoms of depression were associated with worse performance at baseline and follow-up on all 3 tests of cognitive function (P<.001 for all comparisons). For example, the baseline Digit Symbol score (mean±SD) was 45.5±10.7 among women with 0 to 2 symptoms of depression, 40.3±10.7 for women with 3 to 5 symptoms, and 39.0±11.3 for women with 6 or more symptoms. After adjusting for the baseline score, cognitive change scores were also inversely associated with the number of depressive symptoms (P<.001 for all comparisons). Odds ratios for cognitive deterioration using 0 to 2 symptoms as the reference were 1.6 (95% confidence interval, 1.3-2.1) for 3 to 5 symptoms and 2.3 (95% confidence interval, 1.6-3.3) for 6 or more symptoms. Results were similar after being adjusted for education, age, health status, exercise, alcohol use, functional status, and clinic site.

Conclusions  Depressive symptoms in older women are associated with both poor cognitive function and subsequent cognitive decline. Mechanisms underlying the association between these 2 common conditions need further exploration.

From the Departments of Psychiatry (Drs Yaffe and Reus), Neurology (Dr Yaffe), Medicine (Drs Sands and Browner), and Epidemiology and Biostatistics (Ms Blackwell and Drs Gore and Browner), University of California–San Francisco School of Medicine; and the Veterans Affairs Medical Center (Drs Yaffe and Browner), San Francisco.

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