Associations between trajectories of depressive symptoms and rate of cognitive decline among Chinese middle-aged and older adults: An 8-year longitudinal study

Associations between Sarcopenia and trajectories of activities of daily living disability: a nationwide longitudinal study of middle-aged and older adults in China from 2011 to 2018

BACKGROUND

Sarcopenia is an age-related clinical syndrome, which is associated with numerous adverse outcomes among older adults. The relationship between sarcopenia and activities of daily living (ADL) disability has been studied in China, but these findings usually focused on a single time point. The patterns of ADL can change over time and vary among individuals. Therefore, it is necessary to explore the association between sarcopenia and trajectories of ADL disability.

METHODS

According to Asian Working Group for Sarcopenia (AWGS) 2019 criteria, muscle mass, muscle strength, and physical performance measurements were measured to diagnose sarcopenia. A six-item ADL score was used to measure ADL disability, and trajectories of ADL disability were identified by the latent class trajectory modelling (LCTM). Multiple logistic regression models were performed to examine the association between sarcopenia and trajectories of ADL disability.

RESULTS

Among 9113 middle-aged and older adults, three trajectories of ADL disability were determined according to changes in ADL score during follow-up, including a mild-high trajectory (n = 648, 7.11%), followed by the low-mild trajectory (n = 3120, 34.24%) and low-low trajectory (n = 5345, 58.65%). After adjustment for covariates, severe sarcopenia was significantly associated with higher risks of being in the mild-high trajectory group (OR = 3.31, 95%CI: 2.10-5.22) and the low-mild trajectory group (OR = 1.44, 95%CI: 1.05-1.98), compared with the low-low trajectory group. This association was still observed when stratified by age and gender. In addition, participants with sarcopenic obesity were associated with a higher risk of ADL disability (OR = 3.99; 95% CI: 2.50-6.09).

CONCLUSIONS

Among the middle-aged and older Chinese adults, sarcopenia and sarcopenic obesity were both associated with persistent higher trajectories of ADL disability. It suggested that early interventions to sarcopenia and sarcopenic obesity among the middle-aged and older adults may reduce the progression of ADL disability.

Depressive symptoms and cognitive decline in older adults

OBJECTIVES

Few studies have examined the impact of late-life depression trajectories on specific domains of cognitive function. This study aims to delineate how different depressive symptom trajectories specifically affect cognitive function in older adults.

DESIGN

Prospective longitudinal cohort study.

SETTING

Australia and the United States of America.

PARTICIPANTS

In total, 11,035 community-dwelling older adults with a mean age of 75 years.

MEASUREMENTS

Depressive trajectories were modelled from depressive symptoms according to annual Centre for Epidemiological Studies Depression Scale 10 (CES-D-10) surveys. Four trajectories of depressive symptoms were identified: low ("nondepressed"), consistently mild ("subthreshold depression"), consistently moderate ("persistent depression"), and initially low but increasing ("emerging depression"). Global cognition (Modified Mini-Mental State Examination [3MS]), verbal fluency (Controlled Oral Word Association Test [COWAT]), processing speed (Symbol Digit Modalities Test [SDMT]), episodic memory (Hopkins Verbal Learning Test - Revised [HVLT-R]), and a composite z-score were assessed over a subsequent median 2 years.

RESULTS

Subthreshold depression predicted impaired performance on the SDMT (Cohen's d -0.04) and composite score (-0.03); emerging depression predicted impaired performance on the SDMT (-0.13), HVLT-R (-0.09), 3 MS (-0.08) and composite score (-0.09); and persistent depression predicted impaired performance on the SDMT (-0.08), 3 MS (-0.11), and composite score (-0.09).

CONCLUSIONS

Depressive symptoms are associated with later impaired processing speed. These effects are small. Diverse depression trajectories have different impacts on cognitive function.

Cognitive decline among older adults with depressive symptoms before and during the COVID-19 pandemic

BACKGROUND

Whether the COVID-19 pandemic would induce accelerated cognitive decline in individuals with depressive symptoms is undetermined.

OBJECTIVE

To investigate the impact of the COVID-19 pandemic on cognitive function among older adults with depressive symptoms.

METHODS

Data were from the Health and Retirement Study. The interval between wave 13 and wave 14 was defined as the prepandemic period, and the interval between wave 14 and wave 15 was defined as the pandemic period. Linear mixed models and modified Poisson regression models were employed to compare the differences in cognitive decline and incident dementia between participants with and without depressive symptoms before and during the pandemic.

RESULTS

A total of 9304 participants were included. During the prepandemic period, no significant difference was observed in changes in cognitive scores between participants with and without depressive symptoms. During the pandemic period, an accelerated decline in cognitive scores was found between the two groups (global cognition: -0.25, 95 % CI: -0.41 to -0.08, P = 0.004; memory: -0.16, 95 % CI: -0.31 to -0.02, P = 0.030; executive function: -0.08, 95 % CI: -0.15 to -0.02, P = 0.014). Participants with depressive symptoms had a higher risk of developing dementia during the pandemic (RR: 1.48, 95 % CI: 1.17 to 1.88, P < 0.001).

LIMITATIONS

Causal relationship cannot be concluded due to the observational study design.

CONCLUSIONS

Older adults with depressive symptoms suffered more severe cognitive deterioration and had a higher risk of incident dementia during the pandemic, underscoring the need to provide cognitive monitoring and interventions for those with depressive symptoms during the COVID-19 pandemic.

The association between the Short Physical Performance Battery and longitudinal trajectories of depressive symptoms among Chinese older adults

BACKGROUND

In this study, the long-term trajectories of depressive symptoms in a 7-year prospective survey cohort of Chinese older adults were explored. Additionally, the study examined whether there was an independent association between scores on the Short Physical Performance Battery (SPPB) and the different trajectories of depressive symptoms.

METHODS

A total of 2177 elderly individuals had their depressive symptoms assessed based on the Center for Epidemiological Studies-Depression (CES-D) scale in the years 2011, 2013, 2015, and 2018. In addition, their demographic characteristics, chronic diseases, and lifestyle factors were also assessed. The trajectories of depressive symptoms were analysed using the group-based trajectories analysis model. Furthermore, the relationship between the objectively measured SPPB scores and the long-term trajectory of depressive symptoms was explored using multinomial logistic regression.

RESULTS

The group-based trajectory analysis model categorized the trajectories of depressive symptoms across four waves into four groups: persistent low depressive symptoms, increasing depressive symptoms, decreased depressive symptoms, and persistent high depressive symptoms. After controlling for confounding factors, it was observed that a higher baseline SPPB score was associated with an increased likelihood of persistent high depressive symptoms, OR (95% CI) = 0.724 (0.644, 0.814), for the persistent high depressive symptoms versus the persistent low depressive symptoms.

CONCLUSIONS

Low levels of SPPB score are associated with persistent high depressive symptoms in older adults. Conversely, improving physical performance as measured by the SPPB can help reduce the risk of major depressive disorder and persistent depressive disorder in the elderly.

Predictors of Variation in the Cognitive Function Trajectories among Older Adults Living Alone: A Growth Mixture Modeling Approach

BACKGROUND

Considering the global aging population, this study investigates changes in cognitive function and predictive factors among older adults living alone.

METHODS

Using data collected from the Korean Longitudinal Study of Aging (KLoSA), the study examines 1217 participants to identify distinct cognitive change patterns and the variables affecting them.

RESULTS

Two primary cognitive function change types emerged: "High-Level Declining Type" and "Low-Level Stable Type." Although the former initially displayed normal cognitive function, it gradually declined over a period of 14 years until it reached mild cognitive impairment (MCI) levels by the year 2020. While the latter group had lower cognitive function from the beginning and remained stable throughout the study. Older age, female gender, rural residence, lower education, lower income, unemployment, and higher levels of depression were linked to a higher likelihood of belonging to the "Low-Level Stable Type".

CONCLUSIONS

The findings of these studies emphasize the need for proactive interventions and regular cognitive assessments for older individuals living alone, as cognitive impairment can develop even in individuals whose cognitive abilities are initially good. Also, tailored interventions should target specific demographic and socioeconomic groups to mitigate cognitive decline effectively.

The association between longitudinal changes in depressive symptoms and cognitive decline among middle-aged and older Chinese adults

OBJECTIVE

Depression is associated with cognitive impairment and dementia, but few studies have been done on Chinese adults. This study evaluates the relationship between depressive symptoms status and cognitive function in middle-aged and elderly Chinese adults.

METHODS

We included 7,968 participants from the Chinese Health and Retirement Longitudinal Survey (CHRALS) with a follow-up of 4 years. Using the Center for Epidemiological Studies Depression Scale to measure depressive symptoms, with a score of 12 or more indicating elevated depressive symptoms. Adjust covariance analysis and generalized linear analysis were used to investigate the relationship between depressive symptoms status (never, new-onset, remission and persistence) and cognitive decline. Restricted cubic spline regression was used to performed the potential nonlinear associations between depressive symptoms and the change scores of cognitive functions.

RESULTS

During the 4-year follow-up, 1148 participants (14.41%) reported persistent depressive symptoms. The participants who have persistent depressive symptoms with more declines in total cognitive scores (least-square mean = -1.99, 95% CI: -3.70 to -0.27). Compared with never depressive symptoms, participants with persistent depressive symptoms experienced a faster decline in cognitive scores (β = -0.68, 95%CI: -0.98 to -0.38), and small difference (d=0.29) at follow-up. But females with new-onset depression had more cognitive decline than those with persistent depression (least-square mean _new-onset - least-square mean _persistent=-0.10), its differences in males (least-square mean _new-onset - least-square mean _persistent=0.03).

CONCLUSIONS

Participants with persistent depressive symptoms experienced a faster decline in cognitive function, but differently in men and women.

Cognitive Function Trajectories and Factors among Chinese Older Adults with Subjective Memory Decline: CHARLS Longitudinal Study Results (2011-2018)

Older adults with subjective cognitive decline are at increased risk of future pathological cognitive decline and dementia. Subjective memory decline is an early sign of cognitive decline; preventing or slowing cognitive decline in at-risk populations remains an elusive issue. This study aimed to examine the cognitive trajectories and factors in older adults with subjective memory decline. Latent growth curve models (LGCMs) were fitted to examine the cognitive function trajectories and factors among 1465 older adults (aged 60+ years) with subjective memory decline. Data were obtained from four waves from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2018), which is a large nationally representative sample of the Chinese population. The results showed that older adults with better initial cognition had a slower decline rate, which may be accelerated by advanced age, low-level education, a rapid decrease in instrumental activities of daily living (IADL) ability, and rapid increase in depression levels. This study was the first to examine the trajectories of cognitive function and its factors in a high-risk population with subjective memory decline. These findings may guide prevention approaches to tackle the issues of cognitive function decline and dementia.