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J Gerontol A Biol Sci Med Sci. 2006 Dec;61(12):1319-23.

The temporal relationship between depression symptoms and cognitive functioning in older medical patients--prospective or concurrent?

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1
Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada.

Abstract

BACKGROUND:

Epidemiological studies remain inconclusive as to whether old age depression is an independent risk factor, a prodrome, or a clinical concomitant of cognitive impairment. The objective of this study, using repeated measures over a 12-month period, was to examine the short-term temporal relationship between depressive symptoms and cognitive impairment.

METHODS:

Two hundred eighty-one medical inpatients 65 years old or older were followed up with the Hamilton Depression Rating Scale (HDRS) and Mini-Mental State Examination (MMSE) at enrollment and 3, 6, and 12 months later. A repeated-measures mixed linear regression model was used to evaluate the association between HDRS scores and MMSE changes over time and to test competing hypotheses about their temporal sequence.

RESULTS:

After adjusting for age, cardiovascular risk, illness severity, baseline physical and cognitive function, and other covariates, a one-point increase in HDRS score (baseline mean +/- standard deviation: 14.4 +/- 7.4) was associated with a lower MMSE score (-0.03, 95% confidence interval, -0.07 to 0.00) at the same time points, but not with the MMSE at subsequent time points (all p values >.40). There were no statistically significant interactions detected between follow-up time and HDRS scores measured at baseline or during follow-up. These results were confirmed in alternative models using dynamic measures of both HDRS and MMSE changes over each successive follow-up interval.

CONCLUSIONS:

These findings suggest that the short-term relationship between depression symptoms and cognitive functioning may be concurrent or temporary, rather than prospective or protracted, consistent with the clinical concomitant hypothesis.

PMID:
17234828
[Indexed for MEDLINE]
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