Late-onset depressive symptoms increase the risk of dementia in small vessel disease

Neurology. 2016 Sep 13;87(11):1102-9. doi: 10.1212/WNL.0000000000003089. Epub 2016 Aug 12.


Objective: We prospectively investigated the role of depressive symptoms (DS) on all-cause dementia in a population with small vessel disease (SVD), considering onset age of DS and cognitive performance.

Methods: The RUN DMC study (Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Cohort) is a prospective cohort study among 503 older adults with SVD on MRI without dementia at baseline (2006), with a follow-up of 5 years (2012). Kaplan-Meier curves stratified for DS and dementia risk were compared using log-rank test. We calculated hazard ratios using Cox regression analyses.

Results: Follow-up was available for 496 participants (mean baseline age 65.6 years [SD 8.8]; mean follow-up time 5.2 years). All-cause dementia developed in 41 participants. The 5.5-year dementia risk was higher in those with DS (hazard ratio 2.7, 95% confidence interval 1.4-5.2), independent of confounders. This was driven by those with late-onset DS. Five-year cumulative risk difference for dementia was higher in participants with depressive symptoms who had high baseline cognitive performance (no DS 0.0% vs DS 6.9%, log-rank p < 0.001) compared with those who had low cognitive performance at baseline.

Conclusions: Late-onset DS increases dementia risk, independent of SVD. Especially in those with relatively high cognitive performance, DS indicate a higher risk. In contrast to current practice, clinicians should monitor those with DS who also show relatively good cognitive test scores.

MeSH terms

  • Age of Onset
  • Aged
  • Aged, 80 and over
  • Brain / diagnostic imaging
  • Cerebral Small Vessel Diseases / complications
  • Cerebral Small Vessel Diseases / diagnostic imaging
  • Cerebral Small Vessel Diseases / epidemiology*
  • Cerebral Small Vessel Diseases / psychology
  • Dementia / diagnostic imaging
  • Dementia / epidemiology*
  • Depression / diagnostic imaging
  • Depression / epidemiology*
  • Female
  • Follow-Up Studies
  • Humans
  • Kaplan-Meier Estimate
  • Magnetic Resonance Imaging
  • Male
  • Mental Status Schedule
  • Middle Aged
  • Proportional Hazards Models
  • Prospective Studies
  • Risk