Depression and Alzheimer’s Disease Biomarkers Predict Driving Decline

Article type: Research Article

Authors: Babulal, Ganesh M.^{a; b; *} | Chen, Suzie^k | Williams, Monique M.^l | Trani, Jean-Francoisⁱ | Bakhshi, Parul^{g; i} | Chao, Grace L.^j | Stout, Sarah H.^{a; b} | Fagan, Anne M.^{a; b; c} | Benzinger, Tammie L.S.^{a; d; h} | Holtzman, David M.^{b; c} | Morris, John C.^{a; b; c; d; e; f; g} | Roe, Catherine M.^{a; b}

Affiliations: [a] Charles F. and Joanne Knight Alzheimer’s Disease Research Center, Washington University, School of Medicine, St. Louis, MO, USA | [b] Department of Neurology, Washington University, School of Medicine, St. Louis, MO, USA | [c] Hope Center for Neurological Disorders, Washington University, School of Medicine, St. Louis, MO, USA | [d] Department of Radiology, Washington University, School of Medicine, St. Louis, MO, USA | [e] Department of Pathology and Immunology, Washington University, School of Medicine, St. Louis, MO, USA | [f] Department of Physical Therapy, Washington University, School of Medicine, St. Louis, MO, USA | [g] Department of Occupational Therapy, Washington University, School of Medicine, St. Louis, MO, USA | [h] Department of Neurosurgery, Washington University, School of Medicine, St. Louis, MO, USA | [i] Brown School, Washington University, St. Louis, MO, USA | [j] Chicago State University, Chicago, IL, USA | [k] St. Louis College of Pharmacy, St. Louis, MO, USA | [l] BJC Medical Group, St. Louis, MO, USA

Correspondence: [*] Correspondence to: Ganesh M. Babulal, 660 S. Euclid Ave., Campus Box 8111, St. Louis, MO, USA. Tel.: +1 952 334 8536; E-mail: babulalg@wustl.edu.

Abstract: Background:Symptomatic Alzheimer’s disease (AD) and depression independently increase crash risk. Additionally, depression is both a risk factor for and a consequence of AD. Objective:To examine whether a depression diagnosis, antidepressant use, and preclinical AD are associated with driving decline among cognitively normal older adults. Methods:Cognitively normal participants, age ≥65, were enrolled. Cox proportional hazards models evaluated whether a depression diagnosis, depressive symptoms (Geriatric Depression Scale), antidepressant use, cerebrospinal fluid (amyloid-β42 [Aβ42], tau, phosphorylated tau181 [ptau181]), and amyloid imaging biomarkers (Pittsburgh Compound B and Florbetapir) were associated with time to receiving a rating of marginal/fail on a road test. Age was adjusted for in all models. Results:Data were available from 131 participants with age ranging from 65.4 to 88.2 years and mean follow up of 2.4 years (SD = 1.0). A depression diagnosis was associated with a faster time to receiving a marginal/fail rating on a road test and antidepressant use (p = 0.024, HR = 2.62). Depression diagnosis and CSF and amyloid PET imaging biomarkers were associated with driving performance on the road test (p≤0.05, HR = 2.51–3.15). In the CSF ptau181 model, depression diagnosis (p = 0.031, HR = 2.51) and antidepressant use (p = 0.037, HR = 2.50) were statistically significant predictors. There were no interaction effects between depression diagnosis, antidepressant use, and biomarker groups. Depressive symptomology was not a statistically significant predictor of driving performance. Conclusions:While, as previously shown, preclinical AD alone predicts a faster time to receiving a marginal/fail rating, these results suggest that also having a diagnosis of depression accelerates the onset of driving problems in cognitively normal older adults.

Keywords: Alzheimer’s disease, antidepressants, biomarkers, depression, driving, older adults

DOI: 10.3233/JAD-180564

Journal: Journal of Alzheimer's Disease, vol. 66, no. 3, pp. 1213-1221, 2018