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Updated: Aug 11, 2026
Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Depressive symptoms, vascular disease, and mild cognitive impairment: findings from the Cardiovascular Health Study
Deborah E Barnes1, George S Alexopoulos, Oscar L Lopez
1Department of Psychiatry, University of California, San Francisco 94121, USA. barnes@medicine.ucsf.edu
Insights
Depressive symptoms increase the risk of developing mild cognitive impairment (MCI), a precursor to dementia. This association between depressive symptoms and MCI is independent of underlying vascular disease in older adults.
Area of Science:
- Neurology
- Geriatrics
- Psychiatry
Background:
- Depressive symptoms are prevalent in dementia patients and may elevate dementia risk.
- Vascular disease is a potential underlying factor for both depressive symptoms and dementia.
Purpose of the Study:
- To investigate the association between depressive symptoms and the risk of developing mild cognitive impairment (MCI).
- To determine if underlying vascular disease mediates the relationship between depressive symptoms and MCI.
Main Methods:
- A prospective, population-based, longitudinal study of 2220 cognitively healthy adults aged 65+.
- Depressive symptoms assessed using the Center for Epidemiological Studies Depression Scale.
- Vascular disease indicators and MCI diagnosis evaluated over a 6-year follow-up period.
Main Results:
- Higher levels of depressive symptoms correlated with a significantly increased risk of MCI.
- The association between depressive symptoms and MCI risk remained largely unchanged after adjusting for vascular disease and demographics.
- Vascular disease measures independently predicted increased MCI risk, irrespective of depressive symptoms.
Conclusions:
- Depressive symptoms are an independent risk factor for developing MCI in older adults.
- The link between depressive symptoms and MCI is not explained by underlying vascular disease.
Context:
Depressive symptoms are common in patients with dementia and may be associated with increased risk of developing dementia. It has been hypothesized that depressive symptoms and dementia may be attributable to underlying vascular disease in some older persons.
Objectives:
To test the hypotheses (1) that depressive symptoms are associated with increased risk of developing mild cognitive impairment (MCI), a preclinical state that often precedes dementia, and (2) that the association between depressive symptoms and MCI is attributable to underlying vascular disease.
Design:
Prospective, population-based, longitudinal study.
Setting:
Random sample of adults 65 years or older recruited from 4 US communities.
Participants:
Subjects were 2220 participants in the Cardiovascular Health Study Cognition Study with high cognitive function at baseline. Depressive symptoms were measured at baseline using the 10-item Center for Epidemiological Studies Depression Scale and were classified as none (0-2 points), low (3-7 points), and moderate or high (>/=8 points). Vascular disease measures at baseline included confirmed history of stroke, transient ischemic attack, diabetes mellitus, or hypertension; carotid artery stenosis; ankle-arm blood pressure index; and small or large infarcts or white matter disease on cerebral magnetic resonance imaging. Mild cognitive impairment was diagnosed after 6 years of follow-up based on the consensus of a team of dementia experts using standard clinical criteria.
Main Outcome Measure:
Diagnosis of MCI.
Results:
Depressive symptoms at baseline were associated with increased risk of MCI (10.0%, 13.3%, and 19.7% for those with no, low, and moderate or high depressive symptoms, respectively). This association was diminished only slightly by adjustment for vascular disease measures and demographics. Vascular disease measures also were associated with increased risk of MCI, and these associations were not diminished by adjustment for depressive symptoms or demographics.
Conclusion:
Depressive symptoms were associated with increased risk of MCI, and this association was independent of underlying vascular disease.
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