Late-onset depressive symptoms increase the risk of dementia in small vessel disease

• Published in: Neurology Vol. 87; no. 11; p. 1102
• Main Authors: van Uden, Ingeborg W M, van der Holst, Helena M, van Leijsen, Esther M C, Tuladhar, Anil M, van Norden, Anouk G W, de Laat, Karlijn F, Claassen, Jurgen A H R, van Dijk, Ewoud J, Kessels, Roy P C, Richard, Edo, Tendolkar, Indira, de Leeuw, Frank-Erik
• Format: Journal Article
• Language: English
• Published: United States 13.09.2016
• Subjects: Age of Onset; Aged; Aged, 80 and over; Brain - diagnostic imaging; Cerebral Small Vessel Diseases - complications; Cerebral Small Vessel Diseases - diagnostic imaging; Cerebral Small Vessel Diseases - epidemiology; Cerebral Small Vessel Diseases - psychology; Dementia - diagnostic imaging; Dementia - epidemiology; Depression - diagnostic imaging; Depression - epidemiology; Female; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Magnetic Resonance Imaging; Male; Mental Status Schedule; Middle Aged; Proportional Hazards Models; Prospective Studies; Risk
• ISSN: 1526-632X
• DOI: 10.1212/WNL.0000000000003089

We prospectively investigated the role of depressive symptoms (DS) on all-cause dementia in a population with small vessel disease (SVD), considering onset age of DS and cognitive performance. The RUN DMC study (Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Cohort) is a prospective cohort study among 503 older adults with SVD on MRI without dementia at baseline (2006), with a follow-up of 5 years (2012). Kaplan-Meier curves stratified for DS and dementia risk were compared using log-rank test. We calculated hazard ratios using Cox regression analyses. Follow-up was available for 496 participants (mean baseline age 65.6 years [SD 8.8]; mean follow-up time 5.2 years). All-cause dementia developed in 41 participants. The 5.5-year dementia risk was higher in those with DS (hazard ratio 2.7, 95% confidence interval 1.4-5.2), independent of confounders. This was driven by those with late-onset DS. Five-year cumulative risk difference for dementia was higher in participants with depressive symptoms who had high baseline cognitive performance (no DS 0.0% vs DS 6.9%, log-rank p < 0.001) compared with those who had low cognitive performance at baseline. Late-onset DS increases dementia risk, independent of SVD. Especially in those with relatively high cognitive performance, DS indicate a higher risk. In contrast to current practice, clinicians should monitor those with DS who also show relatively good cognitive test scores.