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Late-life depression and risk of vascular dementia and Alzheimer's disease: systematic review and meta-analysis of community-based cohort studies

  • Breno S. Diniz (a1), Meryl A. Butters (a2), Steven M. Albert (a3), Mary Amanda Dew (a2) and Charles F. Reynolds (a2)...

Abstract

Background

Late-life depression may increase the risk of incident dementia, in particular of Alzheimer's disease and vascular dementia.

Aims

To conduct a systematic review and meta-analysis to evaluate the risk of incident all-cause dementia, Alzheimer's disease and vascular dementia in individuals with late-life depression in population-based prospective studies.

Method

A total of 23 studies were included in the meta-analysis. We used the generic inverse variance method with a random-effects model to calculate the pooled risk of dementia, Alzheimer's disease and vascular dementia in older adults with late-life depression.

Results

Late-life depression was associated with a significant risk of all-cause dementia (1.85, 95% CI 1.67-2.04, P< 0.001), Alzheimer's disease (1.65, 95% CI 1.42-1.92, P<0.001) and vascular dementia (2.52, 95% CI 1.77-3.59, P<0.001). Subgroup analysis, based on five studies, showed that the risk of vascular dementia was significantly higher than for Alzheimer's disease (P=0.03).

Conclusions

Late-life depression is associated with an increased risk for all-cause dementia, vascular dementia and Alzheimer's disease. The present results suggest that it will be valuable to design clinical trials to investigate the effect of late-life depression prevention on risk of dementia, in particular vascular dementia and Alzheimer's disease.

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Copyright

COPYRIGHT: © Royal College of Psychiatrists, 2013 

Corresponding author

Meryl A. Butters, PhD, Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213, USA. Email: ButtersMA@upmc.edu

Footnotes

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Declaration of interest

In the past 3 years B.S.D. has received payment for lectures from Novartis and had travel/meeting expenses covered by Pfizer. M.A.B. received remuneration for neuropsychological assessment services on a fee-for-service basis, for clinical trials conducted by Northstar Neuroscience and Medtronic and from Fox Learning Systems for developing computerised neuropsychological tasks for an NIH-funded study. The following pharmaceutical companies provide pharmaceutical supplies for C.F.R.'s NIH-sponsored work: Bristol-Myers Squibb, Forrest Laboratories, Lilly and Pfizer.

Footnotes

References

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  • Cited by 481

  • Access

Late-life depression and risk of vascular dementia and Alzheimer's disease: systematic review and meta-analysis of community-based cohort studies

  • Breno S. Diniz (a1), Meryl A. Butters (a2), Steven M. Albert (a3), Mary Amanda Dew (a2) and Charles F. Reynolds (a2)...

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  • Cited by 481

  • Access

Late-life depression and risk of vascular dementia and Alzheimer's disease: systematic review and meta-analysis of community-based cohort studies

  • Breno S. Diniz (a1), Meryl A. Butters (a2), Steven M. Albert (a3), Mary Amanda Dew (a2) and Charles F. Reynolds (a2)...
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eLetters

Late-life depression and risk of vascular dementia and Alzheimer's disease

Manjeet S. Bhatia
01 July 2013

This is an excellent meta analysis of 23 studies by Breno S.Diniz andhis team indicating depression as a risk factor for vascular dementia and Alzheimer's disease.The risk may be contributed directly or indirectly. Direct linkage could be that Late- life depression is a precursor for dementia (more commonly for vascular dementia)The severity of depression needs to be analysed as increase in severity of depression carries a higher risk for dementia (Chen et al, 2007). The linkage may indirect i.e.depression predisposing or leading to cardiovascular diseases (e.g.hypertension, coronary artery disease), medical disorders (e.g. diabetes mellitus, dyslipidemia)and other comorbid psychiatric disorder (alcohol dependence)(Saunderset al 1991), which may increase the risk for dementia. The contribution of drugs used in treating depression or medicaldisorders also need to be understood.It is equally true that mood disorder(usually depression) is the commonest presentation in dementia especially Alzheimer's disease. Therefore,it becomes equally important to conduct follow up studies to analyse how many patients with late-life depression at time of presentation have co morbid dementia or they develop it in the course of illness (Ownby et al, 2006).There is need to develop biological markers to differentiate pseudo-dementia (due to depression) from true dementia. These markers can also help in detecting at risk patients for dementia, especially Alzheimer's disease.This meta analysis has opened the door for studies to determine depression as a riskfactor for dementia. References:1. Chen Z, Wei L,Qin X,McCracken C, Copeland JR. Severity of depression and risk for subsequent dementia: cohort studies in China and the UK.Br J Psychiatry 2008;193:373-377.2.Saunders PA, Copeland JR, Dewey ME, Davidson IA, McWilliam C, Sharma V, Sullivan CI. Heavy drinking as a risk factor for depression and dementia in elderly men. Findings from the Liverpool longitudinal community study. Br J Psychiatry 1991; 159: 213-6.3. Ownby RL, Crocco E, Acevedo A, John V, Loewenstein D. Depression and risk for Alzheimer disease: systematic review, meta-analysis, and meta regression analysis. Arch Gen Psychiatry 2006 ; 63: 530 -8.

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