INCREASE IN NUMBER OF DEPRESSION SYMPTOMS OVER TIME IS RELATED TO WORSE COGNITIVE OUTCOMES IN OLDER ADULTS WITH TYPE 2 DIABETES

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Objective

Older adults with type 2 diabetes (T2D) are at increased risk for depression, cognitive
decline and dementia compared to those without T2D. Little is known about the association
of simultaneous changes in depression symptoms and cognitive decline over time.

Methods

Subjects [n=1021; mean age 71.6 (SD=4.6); 41.2% female] were initially cognitively
normal participants of the Israel Diabetes and Cognitive Decline (IDCD) study who
underwent evaluations of depression and cognition approximately every 18 months. Cognitive
tests were summarized into four cognitive domains: episodic memory, attention/working
memory, executive functions and semantic categorization. The average of the z-scores
of the four domains defined global cognition. Depression symptoms were assessed using
the Geriatric Depression Scale (GDS), 15-item version. We fit a random coefficients
model of changes in depression and in cognitive functions, adjusting for baseline
sociodemographic and cardiovascular variables.

Results

” Higher number of depression symptoms at baseline was significantly associated with
lower baseline cognitive scores in global cognition (estimate=-0.1175, SE= 0.021,
DF=1014, t=-5.59; p<0.001), executive functions (estimate=-0.186, SE=0.036, DF=1013,
t=-5.15; p=<0.001), semantic categorization (estimate=-0.155, SE=0.029, DF=1008, t=-5.3;
p<0.001) and episodic memory (estimate=-0.08165, SE=0.027, DF=1035, t=-2.92; p=0.0036),
but not with rate of decline in any cognitive domain. During follow-up, a larger increase
in number of depression symptoms, was associated with worse cognitive outcomes in
global cognition (estimate=-0.1053, SE=0.027, DF=1612, t=-3.77; p=0.0002), semantic
categorization (estimate=-0.123, SE=0,036, DF=1583, t=-3.36; p=0.0008) and in episodic
memory (estimate=-0.165, SE=0.055, DF=1622, t=-3.02; p=0.003), but the size of this
effect was constant over time. Conclusion: In elderly with T2D, increase in depression
symptoms over time is associated with parallel cognitive decline, indicating that
the natural course of the two conditions progresses concurrently and suggesting common
underlying mechanisms”.

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