Sex-Specific Associations Between Depressive Symptoms and Risk for Subsequent Dementia

Article type: Research Article

Authors: Heser, Kathrin^{a; *} | Kleineidam, Luca^a | Pabst, Alexander^b | Wiese, Birgitt^c | Roehr, Susanne^b | Löbner, Margrit^b | Hajek, André^d | van der Leeden, Carolin^e | Angermeyer, Matthias C.^{f; g} | Scherer, Martin^e | König, Hans-Helmut^d | Maier, Wolfgang^a | Riedel-Heller, Steffi G.^{b; 1} | Wagner, Michael^{a; h; 1}

Affiliations: [a] Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany | [b] Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany | [c] Institute of General Practice, Working Group Medical Statistics and IT Infrastructure, Hannover Medical School, Hannover, Germany | [d] Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany | [e] Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany | [f] Center for Public Mental Health, Gösing am Wagram, Austria | [g] Dipartimento di Sanità Pubblica, Università degli Studi di Cagliari, Cagliari, Italy | [h] DZNE, German Center for Neurodegenerative Diseases, Bonn, Germany

Correspondence: [] Correspondence to: Dr. Kathrin Heser, Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany. Tel.: +49 0228 287 19827; Fax: +49 0228 287 90 19827; E-mail: Kathrin.Heser@ukbonn.de.

Note: [1] Joint last authorship: These authors contributed equally to this paper.

Abstract: Background:An association between depression and an increased risk for subsequent dementia is well-established. Sexspecific associations are understudied yet. Objective:We aimed to investigate sex-specific associations between depressive symptoms and dementia risk. Methods:Longitudinal analyses were conducted in a pooled data set (n = 4,255, mean age = 80 years) of two prospective cohort studies (LEILA 75+, AgeCoDe). Depressive symptoms were harmonized by dichotomized scores of two different depression screening scales using established cutoffs. Transition to dementia was used as outcome in Cox proportional hazards models. Results:Depressive symptoms at baseline were associated with an increased risk for subsequent dementia, and this association was more pronounced in males (interaction of depressive symptoms × sex: HR = 1.64, 95% CI: 1.02–2.64, p = 0.042) in a model adjusted for study, age, and education. After additional adjustment for subjective and objective cognition, depressive symptoms and their interaction with sex (HR = 1.38, 95% CI: 0.85–2.23, p = 0.188) were no longer significantly associated with the risk for subsequent dementia. Sex-stratified analyses showed stronger and significant associations between depressive symptoms and subsequent dementia in men (e.g., HR= 2.10, 95% CI: 1.36–3.23, p = 0.001, compared to HR= 1.28, 95% CI: 1.04–1.58, p = 0.020, in women). Conclusions:Overall, we provide evidence for a stronger association between depression and dementia in men compared to women. Depressive symptoms should be diagnosed, monitored, and treated, not only due to depression, but also with respect to the risk for subsequent dementia, especially in elderly men.

Keywords: Dementia, depression, depressive symptoms, gender, sex

DOI: 10.3233/JAD-190770

Journal: Journal of Alzheimer's Disease, vol. 74, no. 1, pp. 151-161, 2020