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Depression Risk Factors Differ in Patients With and Without Alzheimer Disease
Depression in patients with Alzheimer disease (AD) have different risk factors than older patients with depression without AD, according to a systematic review and meta-analysis published in the Journal of Alzheimer’s Disease.
“Our study adds to the evidence that risk factors for depression appear to be different to the wider older adult population,” lead author Lindsey Sinclair, PhD, Bristol Medical School, University of Bristol, Bristol, UK, and co-authors noted. “For example, female sex, alcohol use, and stroke are well established as risk factors for depression in the general population.”
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The authors used data from 3 large dementia-focused cohorts: Alzheimer's Disease Neuroimaging Initiative (ADNI), National Alzheimer's Coordinating Center (NACC), and Brain Donor Program (BDR). The study included a total of 2120 participants, including 2120 individuals with AD and 1380 with normal cognition. Depression ratings were available using the Geriatric Depression Scale (GDS), Neuropsychiatric Inventory (NPI), and Cornell Scale for Depression in Dementia (CSDD).
Logistic regression was used to examine potential risk factors, and random effects meta-analysis was used to look for interactions between each risk factor and the presence of cognitive impairment.
The results showed that in individual studies, there was no evidence of a difference in risk factors for depressive symptoms in AD. However, in the meta-analysis, the only risk factor that increased the risk of depressive symptoms in AD was a history of depression. Information on this was only available from 1 study, with an odds ratio of 7.78 (95% CI 4.03–15.03). This difference in risk factors supports suggestions of a different pathological process, though more research is needed.
“Future work should include a more detailed examination of depression in AD in relation to vascular risk factors in larger cohorts or in a meta-analysis,” authors urged. “Examination of regional atrophy, and examination of the genetic underpinnings of depression in AD,” should be included.
The study has several limitations, including the low number of individuals without dementia who developed depressive symptoms and the limited number of participants with persistent depressive symptoms in the ADNI study due to its entry criteria. The study's recruitment process may also have limited the representation of individuals with normal cognition in the 3 cohorts, affecting the power of some analyses, particularly the assessment of risk factors for depressive symptoms between those with and without dementia.
