Estimating associations between antidepressant use and incident mild cognitive impairment in older adults with depression

Abstract

IntroductionPrevious studies have provided equivocal evidence of antidepressant use on subsequent cognitive impairment; this could be due to inconsistent modeling approaches. Our goals are methodological and clinical. We evaluate the impact of statistical modeling approaches on the associations between antidepressant use and risk of Mild Cognitive Impairment (MCI) in older adults with depression. Methods716 participants were enrolled. Our primary analysis employed a time-dependent Cox proportional hazards model. We also implemented two fixed-covariate proportional hazards models-one based on having ever used antidepressants during follow-up, and the other restricted to baseline use only. ResultsTreating antidepressant use as a time-varying covariate, we found no significant association with incident MCI (HR = 0.92, 95% CI: 0.70, 1.20). In contrast, when antidepressant use was treated as a fixed covariate, we observed a significant association between having ever used antidepressants and lower risk of MCI (HR = 0.40, 95% CI: 0.28, 0.56). However, in the baseline-use only model, the association was non-significant (HR = 0.84, 95% CI: 0.60, 1.17).

Factors associated with cognitive performance in residents of long-term care facilities in Northeast Mexico.

“…64 There is no significant association between antidepressants and the risk of incidence of mild CI in elderly patients. 65 A meta-analysis that evaluated the use of antidepressants in cognition found that antidepressants have a modest positive effect in cognition in depressed individuals. 66 In this particular case, the antidepressant intake association with CI may be related to the pathophysiology of depression rather than a direct cause of CI.…”

Uloga depresije u razvoju blagog kognitivnog poremećaja

“…Risk factors for the incidence of MCI in depressed individuals include older age (66,73), cumulative depressive symptoms, longer duration of untreated depression (74, 75), higher severity of depressive symptoms (27,32,66,73,75,(77)(78)(79)(80)(81)(82)(83)(84)(85), high (86), but also low burden of AD pathology (77,87), synergistic additive interaction of physical inactivity and sleep difficulties, clinical depression and clinically significant anxiety (85), male gender (66, 88, 89), lower level of formal education (32,66,84) and current prescriptions for antidepressant use (80,93,94). Simultaneously, the use of antidepressants defined on the basis of ever-reported use has shown to be a protective factor reducing the likelihood of MCI (95).…”

Impact of psychotropic medications on cognition among older adults: a systematic review

“…Nine studies (all cohorts) assessing the cognitive impact of antidepressants on older adults were included in the systematic review (Bartels et al, 2018;Carriere et al, 2015;Heath et al, 2018;Heser et al, 2018;Wang et al, 2016;Goveas et al, 2012;Caballero et al, 2006a;Abdeljalil et al, 2021;La Impact of psychotropic medications on cognition et al, 2019). Six of the nine studies were in Englishspeaking countries, and three were in non-Englishspeaking European countries.…”

“…Available evidence on benzodiazepine use in older adults has demonstrated some association between their use and cognitive decline, although this is not a consistent finding (Gerlach et al, 2021;Osler and Jorgensen, 2020). Evidence on antidepressants has been more mixed, with some studies demonstrating slowing of cognitive decline but other research demonstrating accelerated decline or no change (Han et al, 2020;Kodesh et al, 2019;Wang et al, 2016;Abdeljalil et al, 2021). There is limited evidence on other psychotropic categories, although there is research demonstrating the negative cognitive impact of antipsychotics (Vigen et al, 2011;Kim et al, 2021;Tournier et al, 2022).…”