Specific Dimensions of Depression Have Different Associations With Cognitive Decline in Older Adults With Type 2 Diabetes

Objective: Depression is highly frequent in older adults with Type 2 Diabetes and is associated with cognitive impairment. Yet, little is known about how various depression dimensions differentially affect cognition. We investigated longitudinal associations of specific depression dimensions with cognitive decline. Research Design and Methods: Participants (N=1002) were from the Israel Diabetes and Cognitive Decline study, 65+ years of age with Type 2 Diabetes, not demented at baseline. Participants underwent comprehensive neuropsychological battery at baseline and every 18 months thereafter including domains of Episodic Memory, Attention/Working Memory, Semantic Categorization/Language, Executive Function and Z scores of each domain were averaged and further normalized to calculate Global Cognition. Depression items from Geriatric Depression Scale- 15 items (GDS-15) was measured at each visit and subcategorized to five dimensions: Dysphoric Mood, Withdrawal Apathy-Vigor (entitled apathy), Anxiety, Hopelessness and Memory complaint. Random coefficients models examined association of depression dimensions with baseline and longitudinal cognitive functioning adjusting for socio-demographics and baseline characteristics, including cardiovascular risk factors, physical activity and use of diabetic medications. Result: In the fully adjusted model, at baseline, all dimensions of depression, except for anxiety, were associated with some aspects of cognition (p-values from .01 to <.001). Longitudinally, greater apathy scores were associated with faster decline in executive functions (p=.004), a results that withstood adjustment for multiple comparisons. Associations of other depression dimensions with cognitive decline were not significant (p>0.01). Conclusion: Apathy was associated with a faster cognitive decline in executive functions. These findings highlight the heterogeneity of depression as a clinical construct rather than a single entity and point to apathy as a specific risk factor for cognitive decline among older adults with Type 2 Diabetes.

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Specific Dimensions of Depression Have Different Associations With Cognitive Decline in Older Adults With Type 2 Diabetes

10.2337/figshare.13286318.v1 ◽

2021 ◽

Author(s):

Laili Soleimani ◽

Ramit Ravona-Springer ◽

Hung-Mo Lin ◽

Xiaoyu Liu ◽

Mary Sano ◽

...

Keyword(s):

Type 2 Diabetes ◽

Older Adults ◽

Executive Functions ◽

Cognitive Decline ◽

Geriatric Depression Scale ◽

Depression Scale ◽

Random Coefficients ◽

Neuropsychological Battery ◽

Five Dimensions

Objective: Depression is highly frequent in older adults with Type 2 Diabetes and is associated with cognitive impairment. Yet, little is known about how various depression dimensions differentially affect cognition. We investigated longitudinal associations of specific depression dimensions with cognitive decline. Research Design and Methods: Participants (N=1002) were from the Israel Diabetes and Cognitive Decline study, 65+ years of age with Type 2 Diabetes, not demented at baseline. Participants underwent comprehensive neuropsychological battery at baseline and every 18 months thereafter including domains of Episodic Memory, Attention/Working Memory, Semantic Categorization/Language, Executive Function and Z scores of each domain were averaged and further normalized to calculate Global Cognition. Depression items from Geriatric Depression Scale- 15 items (GDS-15) was measured at each visit and subcategorized to five dimensions: Dysphoric Mood, Withdrawal Apathy-Vigor (entitled apathy), Anxiety, Hopelessness and Memory complaint. Random coefficients models examined association of depression dimensions with baseline and longitudinal cognitive functioning adjusting for socio-demographics and baseline characteristics, including cardiovascular risk factors, physical activity and use of diabetic medications. Result: In the fully adjusted model, at baseline, all dimensions of depression, except for anxiety, were associated with some aspects of cognition (p-values from .01 to <.001). Longitudinally, greater apathy scores were associated with faster decline in executive functions (p=.004), a results that withstood adjustment for multiple comparisons. Associations of other depression dimensions with cognitive decline were not significant (p>0.01). Conclusion: Apathy was associated with a faster cognitive decline in executive functions. These findings highlight the heterogeneity of depression as a clinical construct rather than a single entity and point to apathy as a specific risk factor for cognitive decline among older adults with Type 2 Diabetes.

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Depression is more strongly associated with cognition in elderly women than men with type 2 diabetes

International Psychogeriatrics ◽

10.1017/s104161021800114x ◽

2018 ◽

Vol 31 (04) ◽

pp. 591-595

Author(s):

Laili Soleimani ◽

Ramit Ravona-Springer ◽

Anthony Heymann ◽

Elizabeth Guerrero-Berroa ◽

James Schmeidler ◽

...

Keyword(s):

Type 2 Diabetes ◽

Depressive Symptoms ◽

Cognitive Function ◽

Episodic Memory ◽

Elderly Women ◽

Geriatric Depression Scale ◽

Depression Scale ◽

Neuropsychological Battery ◽

Semantic Categorization

ABSTRACTDepression and cognitive impairment are highly prevalent in type 2 diabetes (T2D), yet little is known about how their relationship varies by sex. We examined this question in a large T2D sample (N = 897) of non-demented elderly (≥ 65) participating in the Israel Diabetes and Cognitive Decline (IDCD) Study. Cognition was evaluated by a comprehensive neuropsychological battery and depressive symptoms were assessed by the Geriatric Depression Scale (GDS). The results showed that in all but the executive function domain, the association of depressive symptoms with poorer cognitive function was stronger in women than men, with a significant interaction for language/semantic categorization and missed significance for episodic memory. When defining clinical depression as GDS of ≥6, women with depression had significantly poorer language/semantic categorization, episodic memory, and overall cognitive function. Inclusion of antidepressants in the model did not alter substantively the associations. Our results suggest that depressed T2D women may have poorer cognitive performance, highlighting the significance of sex-specific personalized management of depression in elderly diabetics.

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Cognitive deficits in older adults with mild cognitive impairment in a two-year follow-up study

Dementia & Neuropsychologia ◽

10.1590/1980-57642018dn12-010003 ◽

2018 ◽

Vol 12 (1) ◽

pp. 19-27 ◽

Cited By ~ 2

Author(s):

Camila de Assis Faria ◽

Heloisa Veiga Dias Alves ◽

Eduarda Naidel Barboza e Barbosa ◽

Helenice Charchat-Fichman

Keyword(s):

Older Adults ◽

Cognitive Decline ◽

Public Hospital ◽

Geriatric Depression Scale ◽

Depression Scale ◽

Elderly Adults ◽

Geriatric Depression ◽

Neuropsychological Battery ◽

Memory Decline

ABSTRACT Characterizing cognitive decline in older adults with MCI over time is important to identify the cognitive profile of those who convert to dementia. Objective: This study examined the two-year cognitive trajectory of elderly adults diagnosed with MCI, from geriatrics and neurology outpatient clinics of a public hospital in Rio de Janeiro. Methods: 62 older adults with MCI were submitted to a neuropsychological battery and re-evaluated after two years. The Mann-Whitney U test was employed to assess differences between groups with respect to education, functioning, the Geriatric Depression Scale and diagnosis. Results: 24.2% converted to dementia after two years. The group with declines in two or more cognitive functions had a higher conversion rate to dementia than the group with decline in executive functions (EF) only (Z = -2.11, p = .04). The EF decline group had higher scores on the depression scale than both the memory decline group (Z = -1.99, p = .05) and multiple decline group (Z = -2.23, p = .03). Conclusion: The present study found different cognitive decline profiles in elderly adults with MCI and differences between them regarding depressive symptoms and rate of conversion to dementia.

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Specific Dimensions of Depression Have Different Associations With Cognitive Decline in Older Adults With Type 2 Diabetes

Diabetes Care ◽

10.2337/dc20-2031 ◽

2021 ◽

Vol 44 (3) ◽

pp. 655-662

Author(s):

Laili Soleimani ◽

Ramit Ravona-Springer ◽

Hung-Mo Lin ◽

Xiaoyu Liu ◽

Mary Sano ◽

...

Keyword(s):

Type 2 Diabetes ◽

Older Adults ◽

Cognitive Decline

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Subjective Cognitive Decline Predicts Concurrent Cognition in Hispanics, but not in Non-Hispanic Whites: A Pilot Study

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acz029.34 ◽

2019 ◽

Vol 34 (7) ◽

pp. 1267-1267

Author(s):

M Nakhla ◽

B Pulido ◽

C Salcedo-Borrego ◽

J Lewis ◽

L Cohen ◽

...

Keyword(s):

Older Adults ◽

Cognitive Decline ◽

Mexican American ◽

Rating Scale ◽

Geriatric Depression Scale ◽

Depression Scale ◽

Subjective Cognitive Decline ◽

Future Research ◽

Cognitive Changes ◽

Hispanic White

Abstract Objective Subjective cognitive decline (SCD) is prevalent among older adults and may be indicative of future cognitive decline. However, the expression of SCD may vary across ethnic groups due to factors such as educational level, awareness of decline, and depression. This study explored whether SCD scores predicted concurrent cognition in Hispanic and Non-Hispanic White older adults, after adjusting for variables known to affect this relationship. Participants and Method Twenty-two Hispanic (mostly Mexican-American) and 27 Non-Hispanic White older adults were recruited from ongoing studies at the University of California, San Diego. The “My Cognition” version of the Subjective Cognitive Decline Questionnaire (SCD-Q) developed in Spain measured SCD (modified to “Mexican” Spanish and administered in language of preference - 55% in Spanish). The Mattis Dementia Rating Scale (DRS) measured global cognition and the Geriatric Depression Scale (GDS) measured mood. Results A hierarchical regression examined if ethnic group moderated the association between SCD-Q total score and DRS total score after adjusting for age, gender, education, and GDS score. Ethnicity moderated the relationship between SCD and DRS (β = -1.071, p = .024). Higher SCD-Q scores significantly predicted lower DRS scores in Hispanics (β = -.97, p < .01), but not in Non-Hispanic Whites (β = -.23, p = .33), after adjusting for co-variates. Education level was the only significant predictor of DRS scores in the Non-Hispanic group. Conclusions Preliminary findings indicate that the SCD-Q may be a sensitive predictor of concurrent cognitive function in Hispanics, compared to Non-Hispanic Whites, suggesting that the SCD-Q may be culturally sensitive. Future studies should replicate these findings and investigate ethnic differences in the correlates of SCD (i.e., education, acculturation, depression reporting), which may account for the current findings. Importantly, future research should investigate if SCD can predict future cognitive changes in Hispanics.

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Metformin Use and Cognitive Function in Older Adults With Type 2 Diabetes Following a Mediterranean Diet Intervention

Frontiers in Nutrition ◽

10.3389/fnut.2021.742586 ◽

2021 ◽

Vol 8 ◽

Author(s):

Natalia Soldevila-Domenech ◽

Aida Cuenca-Royo ◽

Nancy Babio ◽

Laura Forcano ◽

Stephanie Nishi ◽

...

Keyword(s):

Type 2 Diabetes ◽

Older Adults ◽

Glycemic Control ◽

Executive Functions ◽

Mediterranean Diet ◽

Energy Restriction ◽

Neuroprotective Effects ◽

Global Cognition ◽

Control Trajectory

Background and Purpose: Both adherence to the Mediterranean diet (MedDiet) and the use of metformin could benefit the cognitive performance of individuals with type 2 diabetes, but evidence is still controversial. We examined the association between metformin use and cognition in older adults with type 2 diabetes following a MedDiet intervention.Methods: Prospective cohort study framed in the PREDIMED-Plus-Cognition sub-study. The PREDIMED-Plus clinical trial aims to compare the cardiovascular effect of two MedDiet interventions, with and without energy restriction, in individuals with overweight/obesity and metabolic syndrome. The present sub-study included 487 cognitively normal subjects (50.5% women, mean ± SD age of 65.2 ± 4.7 years), 30.4% of them (N = 148) with type 2 diabetes. A comprehensive battery of neurocognitive tests was administered at baseline and after 1 and 3 years. Individuals with type 2 diabetes that exhibited a good glycemic control trajectory, either using or not using metformin, were compared to one another and to individuals without diabetes using mixed-effects models with inverse probability of treatment weights.Results: Most subjects with type 2 diabetes (83.1%) presented a good and stable glycemic control trajectory. Before engaging in the MedDiet intervention, subjects using metformin scored higher in executive functions (Cohen's d = 0.51), memory (Cohen's d = 0.38) and global cognition (Cohen's d = 0.48) than those not using metformin. However, these differences were not sustained during the 3 years of follow-up, as individuals not using metformin experienced greater improvements in memory (β = 0.38 vs. β = 0.10, P = 0.036), executive functions (β = 0.36 vs. β = 0.02, P = 0.005) and global cognition (β = 0.29 vs. β = −0.02, P = 0.001) that combined with a higher MedDiet adherence (12.6 vs. 11.5 points, P = 0.031). Finally, subjects without diabetes presented greater improvements in memory than subjects with diabetes irrespective of their exposure to metformin (β = 0.55 vs. β = 0.10, P < 0.001). However, subjects with diabetes not using metformin, compared to subjects without diabetes, presented greater improvements in executive functions (β = 0.33 vs. β = 0.08, P = 0.032) and displayed a higher MedDiet adherence (12.6 points vs. 11.6 points, P = 0.046).Conclusions: Although both metformin and MedDiet interventions are good candidates for future cognitive decline preventive studies, a higher adherence to the MedDiet could even outweigh the potential neuroprotective effects of metformin in subjects with diabetes.

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