TY - JOUR
T1 - Specific Dimensions of Depression Have Different Associations With Cognitive Decline in Older Adults With Type 2 Diabetes
AU - Soleimani, Laili
AU - Ravona-Springer, Ramit
AU - Lin, Hung Mo
AU - Liu, Xiaoyu
AU - Sano, Mary
AU - Heymann, Anthony
AU - Beeri, Michal Schnaider
N1 - Funding Information:
Acknowledgments. The authors thank Marina Nissim, Milan Italy. Funding. This work is funded by National Institutes of Health grants R01-AG-034087, AG-053446, AG-051545, and AG-043878 to M.S.B. and P50-AG-05138 to M.S. The authors are also grateful for the generosity of the LeRoy Schecter Foundation and to Dr. Marina Nissim Duality of Interest. M.S. serves as a board member of the Alzheimer’s Association, International Psychogeriatric Association, and National Association of Veterans’ Research and Education Foundations; is a consultant on trial design for Eisai, Avenir, vTv, Biogen, BioXcel, and F. Hoffmann La Roche; and has other relationships with and has served on the data safety monitoring board for Syneos. No other potential conflicts of interest relevant to this article were reported. Author Contributions. L.S. contributed to the study design, interpreted data, and drafted/ revised the manuscript. R.R.-S. contributed to the study design, data collection, and review/ revision of the manuscript. H.-M.L. and X.L. contributed to the data analysis and interpretation. M.S. reviewed/revised the manuscript and contributed to the discussion. A.H. contributed to the study design, data collection, and review/revision of the manuscript. M.S.B. contributed to the study design, data analysis and interpretation, and drafting/revision of the manuscript. L.S. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Prior Presentation. Parts of this study were presented in poster form at the Alzheimer’s Association International Conference 2020, Virtual, 27–31 July 2020.
Funding Information:
This work is funded by National Institutes of Health grants R01-AG-034087, AG-053446, AG-051545, and AG-043878 to M.S.B. and P50AG-05138 to M.S. The authors are also grateful for the generosity of the LeRoy Schecter Foundation and to Dr. Marina Nissim.
Publisher Copyright:
© 2021 by the American Diabetes Association.
PY - 2021/5
Y1 - 2021/5
N2 - 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 5 1,002) were from the Israel Diabetes and Cognitive Decline study, were ‡65 years of age, had type 2 diabetes, and were not experiencing dementia at baseline. Participants underwent a comprehensive neuropsychological battery at baseline and every 18 months thereafter, including domains of episodic memory, attention/working memory, semantic categorization/language, and executive function, and Z-scores of each domain were averaged and further normalized to calculate global cognition. Depression items from the 15-item Geriatric Depression Scale were measured at each visit and subcategorized into five dimensions: dysphoric mood, withdrawal-apathy-vigor (entitled apathy), anxiety, hopelessness, and memory complaint. Random coefficients models examined the association of depression dimensions with baseline and longitudinal cognitive functioning, adjusting for sociodemographics and baseline characteristics, including cardiovascular risk factors, physical activity, and use of diabetes medications. RESULTS In the fully adjusted model at baseline, all dimensions of depression, except for anxiety, were associated with some aspect of cognition (P values from 0.01 to <0.001). Longitudinally, greater apathy scores were associated with faster decline in executive function (P 5 0.004), a result that withstood adjustment for multiple comparisons. Associations of other depression dimensions with cognitive decline were not significant (P > 0.01). CONCLUSIONS Apathy was associated with a faster cognitive decline in executive function. These findings highlight the heterogeneity of depression as a clinical construct rather than as a single entity and point to apathy as a specific risk factor for cognitive decline among older adults with type 2 diabetes.
AB - 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 5 1,002) were from the Israel Diabetes and Cognitive Decline study, were ‡65 years of age, had type 2 diabetes, and were not experiencing dementia at baseline. Participants underwent a comprehensive neuropsychological battery at baseline and every 18 months thereafter, including domains of episodic memory, attention/working memory, semantic categorization/language, and executive function, and Z-scores of each domain were averaged and further normalized to calculate global cognition. Depression items from the 15-item Geriatric Depression Scale were measured at each visit and subcategorized into five dimensions: dysphoric mood, withdrawal-apathy-vigor (entitled apathy), anxiety, hopelessness, and memory complaint. Random coefficients models examined the association of depression dimensions with baseline and longitudinal cognitive functioning, adjusting for sociodemographics and baseline characteristics, including cardiovascular risk factors, physical activity, and use of diabetes medications. RESULTS In the fully adjusted model at baseline, all dimensions of depression, except for anxiety, were associated with some aspect of cognition (P values from 0.01 to <0.001). Longitudinally, greater apathy scores were associated with faster decline in executive function (P 5 0.004), a result that withstood adjustment for multiple comparisons. Associations of other depression dimensions with cognitive decline were not significant (P > 0.01). CONCLUSIONS Apathy was associated with a faster cognitive decline in executive function. These findings highlight the heterogeneity of depression as a clinical construct rather than as a single entity and point to apathy as a specific risk factor for cognitive decline among older adults with type 2 diabetes.
UR - http://www.scopus.com/inward/record.url?scp=85102218778&partnerID=8YFLogxK
U2 - 10.2337/DC20-2031
DO - 10.2337/DC20-2031
M3 - Article
C2 - 33468519
AN - SCOPUS:85102218778
VL - 44
SP - 655
EP - 662
JO - Diabetes Care
JF - Diabetes Care
SN - 1935-5548
IS - 3
ER -