Sex Differences in the Relationship between Depressive Symptoms and Risk of Amnestic Mild Cognitive Impairment

Abstract

BACKGROUND The relationship between depressive symptoms and subsequent cognitive impairment in older adults is controversial. Sex differences and the differences in the method of categorizing depressive symptoms may contribute to the inconsistencies. OBJECTIVE To examine the effect of severity of baseline depressive symptoms on risk of incident amnestic mild cognitive impairment (aMCI) separately in men and women. METHODS Community-dwelling and cognitively healthy older adults (aged≥70 years) from the Einstein Aging Study completed the 15-item Geriatric Depression Scale (GDS-15) at their baseline visit. Participants were categorized into “no or low symptoms” (GDS-15 score=0–2), “mild symptoms” (GDS-15 score=3–5) and “moderate/severe symptoms” (GDS-15 score>6) groups. Sex-stratified Cox proportional hazards models, adjusted for age, education, and antidepressant medication, estimated hazard ratios (HR) and 95% confidence intervals (CIs) for incident aMCI as a function of depressive symptoms group. RESULTS We followed 572 women (mean age=78) and 345 men (mean age=77) for 4.2 years on average (range=1.0–14.6 years). Ninety women and 64 men developed aMCI during follow-up. Cox models revealed that compared to no/low depressive symptoms, mild symptoms were associated with a two times greater risk of developing aMCI in men (HR=2.22, 95%CI=1.26–3.89) but not in women (HR=1.26; 95%CI=0.77–2.06). Conversely, moderate/severe depressive symptoms were associated with a two times greater risk of developing aMCI in women (HR=1.99, 95%CI=1.05–3.77) but not in men (HR=0.28, 95%CI=0.04–2.11) possibly due to low statistical power in this subgroup. CONCLUSIONS Results indicate that mild depressive symptoms in men and moderate/severe symptoms in women may represent a marker for future cognitive impairment.

Late life depressive symptoms and cognitive function among older Mexican adults: the past and the present

“…The marginally significant interaction suggested a stronger association between depression and cognition for males than females, which is consistent with prior studies (Biringer et al, 2005;Forno et al, 2005;Paterniti et al, 1999). One study finding mild depressive symptoms to be associated with incident amnestic mild cognitive impairment among men, but not women (Sundermann, Katz, & Lipton, 2017) posited that sex differences may be due to greater depression related changes in medial frontal lobe volume among males (Taki et al, 2005). Sundermann et al (2017) and Forno et al (2005) also attributed their findings to gender based societal expectations which may lead men to be more reluctant to acknowledge depression symptoms due to gender roles of suppressing emotional expression.…”

“…One study finding mild depressive symptoms to be associated with incident amnestic mild cognitive impairment among men, but not women (Sundermann, Katz, & Lipton, 2017) posited that sex differences may be due to greater depression related changes in medial frontal lobe volume among males (Taki et al, 2005). Sundermann et al (2017) and Forno et al (2005) also attributed their findings to gender based societal expectations which may lead men to be more reluctant to acknowledge depression symptoms due to gender roles of suppressing emotional expression. Thus, depressive symptoms reported by men have the potential to be more severe.…”

Factors Predicting the Onset of Amnestic Mild Cognitive Impairment or Alzheimer's Dementia in Persons With Subjective Cognitive Decline

“…Older adults with depressive symptoms (mean age = 79 years) had an increased risk of AD dementia (HR = 1.76) in the Framingham Heart Study ( Saczynski et al, 2010 ). Depressive symptoms were also proposed as a risk factor for the incidence of aMCI with HR ranging from 1.74 to 2.22 in community-dwelling older adults aged >70 years ( Geda et al, 2014 ; Sundermann et al, 2017 ). Given that 75% (179/239) of symptoms were mild in the current study, managing even minor depressive symptoms may be important to delay objective cognitive decline in SCD.…”

“…In addition, individuals with depression had >50% higher risk of developing AD dementia compared to those without depression ( Diniz et al, 2013 ). The presence of depression was also associated with 1.7 to 7.6 times higher risk of development of aMCI in individuals aged >70 years ( Casado Naranjo et al, 2015 ; Geda et al, 2014 ; Sundermann et al, 2017 ).…”

“…Th e presence of depression was also associated Dr. Ahn (https://orcid.org/0000-0002-9492-4970) is Assistant Professor, University of Tennessee College of Nursing, Knoxville, Tennessee; and Ms. Mathiason (https://orcid.org/0000-0002-9520-9565) is Statistician, Dr. Salisbury (https://orcid.org/0000-0002-0117-2643) is Assistant Professor, and Dr. Yu (https://orcid.org/0000-0002-9399-1987) is Professor, University of Minnesota School of Nursing, Minneapolis, Minnesota. with 1.7 to 7.6 times higher risk of development of aMCI in individuals aged >70 years (Casado Naranjo et al, 2015;Geda et al, 2014;Sundermann et al, 2017).…”