Persistent depressive symptoms in some older patients with coronary
artery disease may increase their risk for cognitive decline.
Researchers at the University of Calgary, Alberta, Canada, examined the
association between depression symptoms and changes in cognitive performance in
older patients who have had nonemergency coronary catheterization without prior
revascularization. Researchers also examined whether associations between
depression symptoms and cognitive decline were influenced by the presence of
the apolipoprotein E (APOE) epsilon-4 allele, which is believed to be a genetic
risk factor for Alzheimer’s disease.
The study included 350 participants, 60 years or older. Study
participants were also recipients of coronary artery bypass graft procedures,
percutaneous coronary interventions or medical therapy after catheterization.
Researchers measured a baseline of depressive symptoms and then compared
the baseline with a dynamic measure capturing change from baseline to 12
months. They also compared mean change in cognitive scores from baseline to 6,
12, and 30 months, and from 12 to 30 months.
Study models were adjusted for age, gender, educational level and
baseline cognitive performance. When compared with participants with no
depressive symptoms or baseline-only symptoms, researchers found that
participants with persistent depressive symptoms showed significantly greater
declines in attention/executive function, learning/memory, verbal fluency and
global cognition measures at 30 months (relative to baseline).
Researchers adjusted for sociodemographic and clinical factors and found
persistent depressive symptoms were associated with significantly greater
declines in all cognitive measures from 12 to 30 months. Researchers also found
some evidence of a significantly greater decline in global cognition for
participants with persistent depressive symptoms and the presence of APOE
epsilon-4 allele (mean Mini-Mental State Examination score change = -2.93; 95%
CI, -4.40 to -1.45), but said that further investigation is needed.
“Consequently, a one-time assessment of depressive symptoms may be
inadequate for detecting those at risk of longer-term adverse cognitive and
functional outcomes,” Elizabeth A. Freiheit MA, of the University of
Calgary, and her colleagues wrote. “These findings illustrate the need for
longer-term monitoring of depressive symptom severity and change by clinicians
and other caregivers.”
Disclosures: This study was supported by the Canadian Institutes
of Health Research (CIHR) Institute of Aging, the Medical Services (Alberta)
Inc. Foundation, and the Brenda Strafford Foundation Chair in Geriatric
Medicine. Ms. Freiheit was supported by a Canadian Cardiovascular Outcomes
Research Team doctoral award funded through a CIHR Team Grant in Cardiovascular
Outcomes Research. Dr. Maxwell has received salary support from the Alberta
Heritage Foundation for Medical Research and from the CIHR Institute of Aging
and the Brenda Strafford Foundation Chair in Geriatric Medicine. The
researchers reported no relevant financial disclosures.