Objectives To examine the relationships over time between dual trajectories of depressive symptoms and several cognitive domains. Design 5-year longitudinal study. Setting Population-based cohort. Participants 1978 randomly selected individuals aged 65+ years at recruitment and assessed annually. Measurements Repeated measures of (1) depressive symptoms on the modified Center for Epidemiologic Studies-Depression Scale; (2) composite scores in the cognitive domains of attention, executive function, memory, language, and visuospatial function. Latent class trajectories were identified for depression and for each cognitive domain, and their associations investigated using dual trajectory modeling. Cognitive trajectories with z scores below −1 were designated as persistently low. Results Five depressive symptom trajectories were observed: rarely depressed (60.5%); low-grade, decreasing symptoms (18.5%); low-grade, increasing symptoms (9.6%); moderate-grade symptoms (7.4%); and consistent higher-grade symptoms (4.0%). For each cognitive domain, six trajectories were observed. The rarely depressed and low-grade decreasing symptom groups were the least likely to have persistently low cognition. The symptom trajectory most strongly associated with persistently low functioning in each domain was not the higher-grade group, but rather the low-grade increasing group in the case of attention, and the moderate-grade trajectory in the other four domains. Conclusions Consistently higher-grade depressive symptoms are less strongly associated with poor cognitive functioning than with either moderate or low-grade increasing depressive symptom trajectories, over time and across different domains. Examining both depression and cognition longitudinally allows heterogeneity of both to be addressed, revealing latent groups with potential diagnostic and prognostic implications.

In the medical field, the implementation of Milestones by the Accreditation Council for Graduate Medical Education (ACGME) has provided a common understanding among clinical and academic supervisors and trainees related to the development of core competencies during graduate medical training. These Milestones help establish developmental trajectories and aspirational goals for the trainee. Unfortunately, training in graduate and postgraduate neuroscience lacks a standardized developmental progression of competencies or outcomes expected of trainees. Without such standardizations, it may be difficult for both the mentor and trainee to identify levels of improvement, which may impact the trainee's future success. Here, we discuss the value of developing a nonexhaustive framework that may be used to evaluate trainees with the expectation that it will provide a template to help with the development of future neuroscientists.

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