Late-Life Depressive Symptoms as Partial Mediators in the Associations between Subclinical Cardiovascular Disease with Onset of Mild Cognitive Impairment and Dementia.
Am J Geriatr Psychiatry
; 26(5): 559-568, 2018 05.
Article
in En
| MEDLINE
| ID: mdl-29254675
ABSTRACT
OBJECTIVE:
To study whether depression contributes to the association between subclinical cardiovascular disease (CVD) and dementia, and identify the contribution's magnitude.METHODS:
Among participants from the Cardiovascular Health Study Cognition Study who did not have baseline CVD-related events (N = 2,450), causal mediation methodology was implemented to examine whether late-life depressive symptoms, defined as 10-item Center for Epidemiologic Studies-Depression (mCES-D) Scale scores ≥8 from 2 to 3 years after baseline, partially mediated the association of baseline subclinical CVD (CAC, carotid intimal medial thickness, stenosis, and ankle brachial index) with mild cognitive impairment (MCI)/dementia onset occurring between 5 and 10 years from baseline. The total effect was decomposed into direct and indirect effects (via late-life depressive symptoms), obtained from an accelerated failure time model with weights derived from multivariable logistic regression of late-life depressive symptoms on subclinical CVD. Analyses were adjusted by baseline covariates age, race, sex, poverty status, marital status, body mass index, smoking status, ApoE4 status, and mCES-D.RESULTS:
Participants contributed 20,994 person-years of follow-up with a median follow-up time of 9.4 years. Subclinical CVD was associated with 12% faster time to MCI/dementia (time ratio [TR] 0.88; 95% CI 0.83, 0.93). The total effect of subclinical CVD on MCI/dementia onset was decomposed into a direct effect (TR 0.95, 95% CI 0.92, 0.98) and indirect effect (TR 0.92, 95% CI 0.88, 0.97); 64.5% of the total effect was mediated by late-life depressive symptoms.CONCLUSIONS:
These data suggest late-life depressive symptoms partially mediate the association of subclinical CVD with MCI/dementia onset.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Cardiovascular Diseases
/
Dementia
/
Depressive Disorder
/
Cognitive Dysfunction
Type of study:
Clinical_trials
/
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Prevalence_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Aged
/
Female
/
Humans
/
Male
Country/Region as subject:
America do norte
Language:
En
Journal:
Am J Geriatr Psychiatry
Journal subject:
GERIATRIA
/
PSIQUIATRIA
Year:
2018
Document type:
Article