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Clinical factors associated with progression to dementia in people with late-life depression: a cohort study of patients in secondary care

OBJECTIVES: Depression can be a prodromal feature or a risk factor for dementia. We aimed to investigate which clinical factors in patients with late-life depression are associated with a higher risk of developing dementia and a more rapid conversion. DESIGN: Retrospective cohort study. SETTING: Sou...

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Autores principales: Peakman, Georgia, Karunatilake, Nishshanka, Seynaeve, Mathieu, Perera, Gayan, Aarsland, Dag, Stewart, Robert, Mueller, Christoph
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7252968/
https://www.ncbi.nlm.nih.gov/pubmed/32448792
http://dx.doi.org/10.1136/bmjopen-2019-035147
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author Peakman, Georgia
Karunatilake, Nishshanka
Seynaeve, Mathieu
Perera, Gayan
Aarsland, Dag
Stewart, Robert
Mueller, Christoph
author_facet Peakman, Georgia
Karunatilake, Nishshanka
Seynaeve, Mathieu
Perera, Gayan
Aarsland, Dag
Stewart, Robert
Mueller, Christoph
author_sort Peakman, Georgia
collection PubMed
description OBJECTIVES: Depression can be a prodromal feature or a risk factor for dementia. We aimed to investigate which clinical factors in patients with late-life depression are associated with a higher risk of developing dementia and a more rapid conversion. DESIGN: Retrospective cohort study. SETTING: South London and Maudsley NHS Foundation Trust (SLaM) secondary mental healthcare services. PARTICIPANTS: The SLaM Clinical Record Interactive Search was used to retrieve anonymised data on 3659 patients aged 65 years or older who had received a diagnosis of depression in mental health services and had been followed up for at least 3 months. OUTCOME MEASURES: Predictors of development of incident dementia were investigated, including demographic factors, health status rated on the Health of the National Outcome scale for older people (HoNOS65+), depression recurrence and treatments including psychotropic drugs and cognitive behavioural therapy (CBT). RESULTS: In total, 806 (22.0%) patients developed dementia over a mean follow-up time of 2.7 years. Significant predictors of receiving a dementia diagnosis in fully adjusted models and after accounting for multiple comparisons were older age (adjusted HR=1.04, 95% CI 1.03 to 1.06 per year difference from sample mean) and the HoNOS65+ subscale measuring cognitive problems (HR=4.72, 95% CI 3.67 to 6.06 for scores in the problematic range). Recurrent depressive disorder or past depression (HR=0.65, 95% CI 0.55 to 0.77) and the receipt of CBT (HR=0.73 95% CI 0.61 to 0.87) were associated with a lower dementia risk. Over time, hazards related to age increased and hazards related to cognitive problems decreased. CONCLUSIONS: In older adults with depression, a higher risk of being subsequently diagnosed with dementia was predicted by higher age, new onset depression, severity of cognitive symptoms and not receiving CBT. Further exploration is needed to determine whether the latter risk factors are responsive to interventions.
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spelling pubmed-72529682020-06-05 Clinical factors associated with progression to dementia in people with late-life depression: a cohort study of patients in secondary care Peakman, Georgia Karunatilake, Nishshanka Seynaeve, Mathieu Perera, Gayan Aarsland, Dag Stewart, Robert Mueller, Christoph BMJ Open Mental Health OBJECTIVES: Depression can be a prodromal feature or a risk factor for dementia. We aimed to investigate which clinical factors in patients with late-life depression are associated with a higher risk of developing dementia and a more rapid conversion. DESIGN: Retrospective cohort study. SETTING: South London and Maudsley NHS Foundation Trust (SLaM) secondary mental healthcare services. PARTICIPANTS: The SLaM Clinical Record Interactive Search was used to retrieve anonymised data on 3659 patients aged 65 years or older who had received a diagnosis of depression in mental health services and had been followed up for at least 3 months. OUTCOME MEASURES: Predictors of development of incident dementia were investigated, including demographic factors, health status rated on the Health of the National Outcome scale for older people (HoNOS65+), depression recurrence and treatments including psychotropic drugs and cognitive behavioural therapy (CBT). RESULTS: In total, 806 (22.0%) patients developed dementia over a mean follow-up time of 2.7 years. Significant predictors of receiving a dementia diagnosis in fully adjusted models and after accounting for multiple comparisons were older age (adjusted HR=1.04, 95% CI 1.03 to 1.06 per year difference from sample mean) and the HoNOS65+ subscale measuring cognitive problems (HR=4.72, 95% CI 3.67 to 6.06 for scores in the problematic range). Recurrent depressive disorder or past depression (HR=0.65, 95% CI 0.55 to 0.77) and the receipt of CBT (HR=0.73 95% CI 0.61 to 0.87) were associated with a lower dementia risk. Over time, hazards related to age increased and hazards related to cognitive problems decreased. CONCLUSIONS: In older adults with depression, a higher risk of being subsequently diagnosed with dementia was predicted by higher age, new onset depression, severity of cognitive symptoms and not receiving CBT. Further exploration is needed to determine whether the latter risk factors are responsive to interventions. BMJ Publishing Group 2020-05-24 /pmc/articles/PMC7252968/ /pubmed/32448792 http://dx.doi.org/10.1136/bmjopen-2019-035147 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Mental Health
Peakman, Georgia
Karunatilake, Nishshanka
Seynaeve, Mathieu
Perera, Gayan
Aarsland, Dag
Stewart, Robert
Mueller, Christoph
Clinical factors associated with progression to dementia in people with late-life depression: a cohort study of patients in secondary care
title Clinical factors associated with progression to dementia in people with late-life depression: a cohort study of patients in secondary care
title_full Clinical factors associated with progression to dementia in people with late-life depression: a cohort study of patients in secondary care
title_fullStr Clinical factors associated with progression to dementia in people with late-life depression: a cohort study of patients in secondary care
title_full_unstemmed Clinical factors associated with progression to dementia in people with late-life depression: a cohort study of patients in secondary care
title_short Clinical factors associated with progression to dementia in people with late-life depression: a cohort study of patients in secondary care
title_sort clinical factors associated with progression to dementia in people with late-life depression: a cohort study of patients in secondary care
topic Mental Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7252968/
https://www.ncbi.nlm.nih.gov/pubmed/32448792
http://dx.doi.org/10.1136/bmjopen-2019-035147
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