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Specific Dimensions of Depression Have Different Associations With Cognitive Decline in Older Adults With Type 2 Diabetes

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posted on 20.01.2021, 17:24 by Laili Soleimani, Ramit Ravona-Springer, Hung-Mo Lin, Xiaoyu Liu, Mary Sano, Anthony Heymann, Michal Schnaider Beeri
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=1002) were from the Israel Diabetes and Cognitive Decline study, 65+ years of age with Type 2 Diabetes, not demented at baseline. Participants underwent comprehensive neuropsychological battery at baseline and every 18 months thereafter including domains of Episodic Memory, Attention/Working Memory, Semantic Categorization/Language, Executive Function and Z scores of each domain were averaged and further normalized to calculate Global Cognition. Depression items from Geriatric Depression Scale- 15 items (GDS-15) was measured at each visit and subcategorized to five dimensions: Dysphoric Mood, Withdrawal Apathy-Vigor (entitled apathy), Anxiety, Hopelessness and Memory complaint. Random coefficients models examined association of depression dimensions with baseline and longitudinal cognitive functioning adjusting for socio-demographics and baseline characteristics, including cardiovascular risk factors, physical activity and use of diabetic medications.

Result: In the fully adjusted model, at baseline, all dimensions of depression, except for anxiety, were associated with some aspects of cognition (p-values from .01 to <.001). Longitudinally, greater apathy scores were associated with faster decline in executive functions (p=.004), a results that withstood adjustment for multiple comparisons. Associations of other depression dimensions with cognitive decline were not significant (p>0.01).

Conclusion: Apathy was associated with a faster cognitive decline in executive functions. These findings highlight the heterogeneity of depression as a clinical construct rather than a single entity and point to apathy as a specific risk factor for cognitive decline among older adults with Type 2 Diabetes.


This work is funded by NIH grants R01AG034087, AG053446, AG051545 and AG043878 to Dr. Beeri, and P50 AG05138 to Dr. Sano. We are also grateful to the generosity of the LeRoy Schecter Foundation and to Dr. Marina Nissim. The results of the study was presented as a poster at the Alzheimer’s Association International Conference (AAIC) 2020 (virtual event).