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Zang E, Zhang Y, Wang Y, Wu B, Fried TR, Becher RD, Gill TM. Association Between Cognitive Trajectories and Subsequent Health Status, Depressive Symptoms, and Mortality Among Older Adults in the United States: Findings From a Nationally Representative Study. J Gerontol A Biol Sci Med Sci 2024; 79:glae143. [PMID: 38845419 PMCID: PMC11212484 DOI: 10.1093/gerona/glae143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Cognitive decline may be an early indicator of major health issues in older adults, though research using population-based data is lacking. Researchers objective was to assess the relationships between distinct cognitive trajectories and subsequent health outcomes, including health status, depressive symptoms, and mortality, using a nationally representative cohort. METHODS Data were drawn from the National Health and Aging Trends Study. Global cognition was assessed annually between 2011 and 2018. The health status of 4 413 people, depressive symptoms in 4 342 individuals, and deaths among 5 955 living respondents were measured in 2019. Distinct cognitive trajectory groups were identified using an innovative Bayesian group-based trajectory model. Ordinal logistic, Poisson, and logistic regression models were used to examine the associations between cognitive trajectories and subsequent health outcomes. RESULTS Researchers identified five cognitive trajectory groups with distinct baseline values and subsequent changes in cognitive function. Compared with the group with stably high cognitive function, worse cognitive trajectories (ie, lower baseline values and sharper declines) were associated with higher risks of poor health status, depressive symptoms, and mortality, even after adjusting for relevant covariates. CONCLUSIONS Among older adults, worse cognitive trajectories are strongly associated with subsequent poor health status, high depressive symptoms, and high mortality risks. Regular screening of cognitive function may help to facilitate early identification and interventions for older adults susceptible to adverse health outcomes.
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Affiliation(s)
- Emma Zang
- Department of Sociology, Yale University, New Haven, Connecticut, USA
| | - Yunxuan Zhang
- Department of Biostatistics, Yale University, New Haven, Connecticut, USA
| | - Yi Wang
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, USA
| | - Terri R Fried
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut, USA
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Robert D Becher
- Division of General Surgery, Trauma, and Surgical Critical Care, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Thomas M Gill
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut, USA
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Ren Z, Nie L, Du Y, Liu J. Intertwined depressive and cognitive trajectories and the risk of dementia and death in older adults: a competing risk analysis. Gen Psychiatr 2024; 37:e101156. [PMID: 38616970 PMCID: PMC11015173 DOI: 10.1136/gpsych-2023-101156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 02/20/2024] [Indexed: 04/16/2024] Open
Abstract
Background Depressive symptoms and cognitive impairment often interact, rendering their associations controversial. To date, their joint trajectories and associations with dementia and death remain underexplored. Aims To explore the interactions between depressive symptoms and cognitive function, their developmental trajectories and the associations with all-cause dementia, Alzheimer's disease (AD) and all-cause death in older adults. Methods Data were from the Health and Retirement Study. Depressive symptoms and cognitive function were measured using the 8-item Centre for Epidemiologic Studies Depression Scale and the Telephone Interview of Cognitive Status, respectively. All-cause dementia and AD were defined by self-reported or proxy-reported physician diagnoses. All-cause death was determined by interviews. The restricted cubic spline, group-based trajectory modelling and subdistribution hazard regression were used. Results Significant interactions between depressive symptoms and cognitive function in 2010 in their association with new-onset all-cause dementia and AD from 2010 to 2020 were found, especially in women (p for interaction <0.05). Independent trajectory analysis showed that emerging or high (vs no) depressive trajectories and poor or rapidly decreased cognitive trajectories (vs very good) from 1996 to 2010 were at significantly higher risk of subsequent all-cause dementia, AD and all-cause death. 15 joint trajectories of depressive symptoms and cognitive function from 1996 to 2010 were determined, where rapidly decreased cognitive function was more common in those with no depressive symptoms. Compared with older adults with the trajectory of no depressive symptoms and very good cognitive function, those with the trajectory of no depressive symptoms but rapidly decreased cognitive function were much more likely to develop new-onset all-cause dementia and death, with subdistribution hazard ratios (95% confidence intervals) of 4.47 (2.99 to 6.67) and 1.84 (1.43 to 2.36), especially in women. Conclusions To effectively mitigate the risk of dementia and death, it is crucial to acknowledge the importance of preventing cognitive decline in older adults without depressive symptoms, particularly in women.
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Affiliation(s)
- Ziyang Ren
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Lirong Nie
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Yushan Du
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jufen Liu
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
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Sousa RD, Henriques AR, Caldas de Almeida J, Canhão H, Rodrigues AM. Unraveling Depressive Symptomatology and Risk Factors in a Changing World. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6575. [PMID: 37623161 PMCID: PMC10454694 DOI: 10.3390/ijerph20166575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND This study aimed to examine the prevalence and factors associated with symptoms of depression during the third wave of the COVID-19 pandemic. METHODS A representative sample of Portuguese adults was included in this populational survey, conducted between 25 March and 31 July 2021, with participants completing a structured questionnaire via phone interview. The symptoms of depression were measured using the Portuguese version of the Hospital Anxiety and Depression Scale (HADS). Multivariate logistic regression analyses were used to examine the association between sociodemographic, health, and lifestyle factors and depression levels (normal, mild, or moderate/severe). RESULTS The estimated prevalence of depression symptoms among participants was 24%. Participants who were women, were in older age groups, had multimorbidity, lived in isolated Portuguese regions such as islands and Alentejo, and were retired or unemployed more frequently reported depression symptoms. Economic hardship was also found to be associated with an increased frequency of mild or moderate-to-severe depression. In contrast, higher levels of education, regular alcohol intake, and regular exercise were associated with a lower frequency of depression symptoms. CONCLUSIONS These findings highlight that during the third wave of the COVID-19 pandemic, a high proportion of Portuguese adults reported depression symptoms, particularly the COVID-19-vulnerable strata such seniors, patients with multimorbidity, and people in economic hardship. On the other hand, citizens who performed regular physical exercise reported lower depressive symptomology. Our work contributes to improving the planning of mental health promotion after the COVID-19 pandemic and future emergencies.
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Affiliation(s)
- Rute Dinis Sousa
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal; (A.R.H.); (J.C.d.A.); (H.C.); (A.M.R.)
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Xie Y, Ma M, Wang W. Trajectories of depressive symptoms and their predictors in Chinese older population: Growth Mixture model. BMC Geriatr 2023; 23:372. [PMID: 37328803 PMCID: PMC10276362 DOI: 10.1186/s12877-023-04048-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 05/17/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Given the rapidly rising proportion of the older population in China and the relatively high prevalence of depressive symptoms among this population, this study aimed to identify the trajectories of depressive symptoms and the factors associated with the trajectory class to gain a better understanding of the long-term course of depressive symptoms in this population. METHODS Data were obtained from four wave's survey of the China Health and Retirement Longitudinal Study (CHARLS). A total of 3646 participants who aged 60 years or older during baseline survey, and completed all follow-ups were retained in this study. Depressive symptoms were measured using the 10-item version of the Center for Epidemiologic Studies Depression Scale (CES-D-10). Growth mixture modelling (GMM) was adopted to identify the trajectory classes of depressive symptoms, and both linear and quadratic functions were considered. A multivariate logistic regression model was used to calculate the adjusted odds ratios (ORs) of the associated factors to predict the trajectory class of participants. RESULTS A four-class quadratic function model was the best-fitting model for the trajectories of depressive symptoms in the older Chinese population. The four trajectories were labelled as increasing (16.70%), decreasing (12.31%), high and stable (7.30%), and low and stable (63.69%), according to their trends. Except for the low and stable trajectory, the other trajectories were almost above the threshold for depressive symptoms. The multivariate logistic regression model suggested that the trajectories of chronic depressive symptoms could be predicted by being female, living in a village (rural area), having a lower educational level, and having chronic diseases. CONCLUSIONS This study identified four depressive symptom trajectories in the older Chinese population and analysed the factors associated with the trajectory class. These findings can provide references for prevention and intervention to reduce the chronic course of depressive symptoms in the older Chinese population.
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Affiliation(s)
- Yaofei Xie
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei, China
- Department of Psychiatry, Wuhan Hospital for Psychotherapy, Wuhan, Hubei, China
| | - Mengdi Ma
- Wuhan Blood Center, Wuhan, Hubei, China.
| | - Wei Wang
- School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Center for Medical Statistics and Data Analysis, Xuzhou Medical University, Xuzhou, Jiangsu, China
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Zang E, Wang X, Shi Y, Wu B, Fried TR. Prediction of physical functioning and general health status trajectories on mortality among persons with cognitive impairment. BMC Geriatr 2022; 22:766. [PMID: 36131230 PMCID: PMC9494770 DOI: 10.1186/s12877-022-03446-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/07/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The concern posed by the confluence of aging and cognitive impairment is growing in importance as the U.S. population rapidly ages. As such, we sought to examine the predictive power of physical functioning (PF) and general health status (GHS) trajectories on mortality outcomes among persons with cognitive impairment (PCIs). METHODS We used group-based trajectory models to identify latent group memberships for PF trajectories in 1,641 PCIs and GHS trajectories in 2,021 PCIs from the National Health and Aging Trends Survey (2011-2018) and applied logistic regressions to predict mortality using these memberships controlling for individual characteristics. RESULTS We identified six trajectory groups for PF and four groups for GHS. Trajectory group memberships for both outcomes significantly predicted mortality. For PF, group memberships largely captured the average levels over time, and worse trajectories (i.e., lower baselines and faster declines) were associated with higher odds of death. The highest mortality risk was associated with the group experiencing a sharp decline early in its PF trajectory, although its average level across time was not the lowest. For GHS, we observed two groups with comparable average levels across time, but the one with a convex-shape trajectory had much higher mortality risks compared to the one with a concave-shape trajectory. CONCLUSIONS Our findings highlighted that health trajectories predicted mortality among PCIs, not only because of general levels but also because of the shapes of declines. Close monitoring health deterioration of PCIs is crucial to understand the health burden of this population and to make subsequent actions.
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Affiliation(s)
- Emma Zang
- Department of Sociology, Yale University, New Haven, CT, 06520, USA.
- Department of Biostatistics, Yale University, New Haven, CT, 06520, USA.
| | - Xueqing Wang
- Office of Population Research, Princeton University, Princeton, NJ, 08540, USA
- School of Public and International Affairs, Princeton University, Princeton, NJ, 08540, USA
| | - Yu Shi
- Department of Biostatistics, Yale University, New Haven, CT, 06520, USA
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NY, 10010, USA
| | - Terri R Fried
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, 06516, USA
- Department of Medicine, Yale School of Medicine, New Haven, CT, 06520, USA
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