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Findings From the Cardiovascular Health Study

Deborah E. Barnes, PhD, MPH; George S. Alexopoulos, MD; Oscar L. Lopez, MD; Jeff D. Williamson, MD, MHS; Kristine Yaffe, MD

Arch Gen Psychiatry. 2006;63:273-279.

Context  Depressive symptoms are common in patients with dementia and may be associated with increased risk of developing dementia. It has been hypothesized that depressive symptoms and dementia may be attributable to underlying vascular disease in some older persons.

Objectives  To test the hypotheses (1) that depressive symptoms are associated with increased risk of developing mild cognitive impairment (MCI), a preclinical state that often precedes dementia, and (2) that the association between depressive symptoms and MCI is attributable to underlying vascular disease.

Design  Prospective, population-based, longitudinal study.

Setting  Random sample of adults 65 years or older recruited from 4 US communities.

Participants  Subjects were 2220 participants in the Cardiovascular Health Study Cognition Study with high cognitive function at baseline. Depressive symptoms were measured at baseline using the 10-item Center for Epidemiological Studies Depression Scale and were classified as none (0-2 points), low (3-7 points), and moderate or high (8 points). Vascular disease measures at baseline included confirmed history of stroke, transient ischemic attack, diabetes mellitus, or hypertension; carotid artery stenosis; ankle-arm blood pressure index; and small or large infarcts or white matter disease on cerebral magnetic resonance imaging. Mild cognitive impairment was diagnosed after 6 years of follow-up based on the consensus of a team of dementia experts using standard clinical criteria.

Main Outcome Measure  Diagnosis of MCI.

Results  Depressive symptoms at baseline were associated with increased risk of MCI (10.0%, 13.3%, and 19.7% for those with no, low, and moderate or high depressive symptoms, respectively). This association was diminished only slightly by adjustment for vascular disease measures and demographics. Vascular disease measures also were associated with increased risk of MCI, and these associations were not diminished by adjustment for depressive symptoms or demographics.

Conclusion  Depressive symptoms were associated with increased risk of MCI, and this association was independent of underlying vascular disease.

Author Affiliations: Departments of Psychiatry (Drs Barnes and Yaffe), Neurology, and Epidemiology and Biostatistics (Dr Yaffe), University of California, San Francisco; Department of Psychiatry, Weill Medical College of Cornell University, Ithaca, NY (Dr Alexopoulos); Departments of Neurology and Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pa (Dr Lopez); and Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC (Dr Williamson).

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