Depression with melancholic features is associated with higher long-term risk for dementia

Frederico Simões do Couto; Nuno Lunet; Sandra Ginó; Catarina Chester; Vanda Freitas; Carolina Maruta; Maria Luísa Figueira; Alexandre de Mendonça

doi:10.1016/j.jad.2016.05.026

Depression with melancholic features is associated with higher long-term risk for dementia

J Affect Disord. 2016 Sep 15:202:220-9. doi: 10.1016/j.jad.2016.05.026. Epub 2016 May 26.

Authors

Frederico Simões do Couto¹, Nuno Lunet², Sandra Ginó³, Catarina Chester³, Vanda Freitas³, Carolina Maruta³, Maria Luísa Figueira⁴, Alexandre de Mendonça³

Affiliations

¹ Dementia Study Group, Institute of Molecular Medicine, Faculdade de Medicina, Universidade de Lisboa, Portugal; Psychiatry and Psychology Department, Faculdade de Medicina, Universidade de Lisboa, Portugal. Electronic address: fcouto@medicina.ulisboa.pt.
² Department of Clinical Epidemiology, Predictive Medicine and Public Health, Faculty of Medicine, University of Porto, Porto, Portugal; EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal.
³ Dementia Study Group, Institute of Molecular Medicine, Faculdade de Medicina, Universidade de Lisboa, Portugal.
⁴ Psychiatry and Psychology Department, Faculdade de Medicina, Universidade de Lisboa, Portugal.

PMID: 27267294
DOI: 10.1016/j.jad.2016.05.026

Abstract

Background: Depression has been reported to increase the risk of subsequently developing dementia, but the nature of this relation remains to be elucidated. Depression can be a prodrome/manifestation of dementia or an early risk factor, and the effect may differ according to depression subtypes. Our aim was to study the association between early-onset depression and different depression subtypes, and the later occurrence of dementia.

Methods: We conducted a cohort study including 322 subjects with depression, recruited between 1977 and 1984. A comparison cohort (non-exposed) was recruited retrospectively, to include 322 subjects admitted at the same hospital for routine surgery (appendicectomy or cholecystectomy), at the same period as the depressed cohort. Subjects were contacted again between 2009 and 2014, to assess their dementia status. We computed the risk for dementia in subjects with early onset depression and quantified the association between different depression subtypes (namely melancholic, anxious, and psychotic) and dementia.

Results: The odds of dementia were increased by 2.90 times (95% C.I. 1.61-5.21; p<0.0001) for the depressed cohort when compared to the surgical cohort. When the analysis was restricted to patients younger than 45 years old at baseline, the odds for dementia in the depressed cohort were also significantly higher when compared to the surgical cohort (8.53; 95% C.I. 2.40-30.16). In the multivariate Cox analysis, subjects having depression with melancholic features had an increased risk for developing dementia compared to those without melancholic features (HR=3.64; 95% C.I. 1.78-11.26; p=0.025).

Limitations: About 59% of the participants with depression and 53% of those non-exposed were lost during follow up. The inclusion of biological biomarkers would strengthen the results. The sample included a low number of bipolar patients.

Conclusions: These results support depression as an early risk factor for dementia. Depression with melancholic features was found as an important risk factor for dementia, playing a main role in the relation between these disorders.

Keywords: Dementia; Depression; Hypothalamus-Hypophysis-adrenal axis; Melancholia; Risk factor.

Publication types

Comparative Study

MeSH terms

Aged
Cohort Studies
Dementia / diagnosis*
Dementia / psychology*
Depression / diagnosis
Depression / psychology
Depressive Disorder / diagnosis
Depressive Disorder / psychology*
Female
Humans
Male
Middle Aged
Retrospective Studies
Risk Factors