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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...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2020
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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. |
format | Online Article Text |
id | pubmed-7252968 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
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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