@article {891, title = {Depressive symptoms, vascular disease, and mild cognitive impairment: findings from the Cardiovascular Health Study.}, journal = {Arch Gen Psychiatry}, volume = {63}, year = {2006}, month = {2006 Mar}, pages = {273-9}, abstract = {

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.

}, keywords = {Aged, Cerebrovascular Disorders, Cognition Disorders, Comorbidity, Dementia, Dementia, Vascular, Depressive Disorder, Female, Follow-Up Studies, Geriatric Assessment, Humans, Longitudinal Studies, Male, Prospective Studies, Psychiatric Status Rating Scales, Risk Factors, Sampling Studies, Vascular Diseases}, issn = {0003-990X}, doi = {10.1001/archpsyc.63.3.273}, author = {Barnes, Deborah E and Alexopoulos, George S and Lopez, Oscar L and Williamson, Jeff D and Yaffe, Kristine} } @article {1300, title = {Subclinical vascular disease burden and risk for death and cardiovascular events in older community dwellers.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {66}, year = {2011}, month = {2011 Sep}, pages = {986-93}, abstract = {

BACKGROUND: Individual measures and previous composite measures of subclinical vascular disease defined high risk for cardiovascular events, but did not detect low and modest risk. A different approach might better describe the spectrum from low to high risk. Methods and Results. In the Cardiovascular Health Study, 3,252 participants without history of clinical cardiovascular disease (M {\textpm} SD 74.3 years {\textpm} 5.1, 63\% women, 17\% African Americans) had noninvasive vascular assessments in 1992-1993. We assigned a score of 0, 1, or 2 (no, mild, or severe abnormalities) to ankle-arm index, electrocardiogram, and common carotid intima-media thickness, based on clinical cutoffs. A summary index (range 0-6, absent to severe disease) summed individual scores. Abdominal aortic ultrasound and brain magnetic resonance imaging were collected in a subsample. Mortality and incident cardiovascular events were identified through June 2008. Event and death rates increased across index grades. Comparing grades 1 to 5+ with absent disease, and adjusting for demographics, hazard ratios for cardiovascular events within 8 years ranged from 1.1 (95\% confidence interval 0.8-1.6) to 4.7 (3.4-6.9) and, for mortality, from 1.5 (1.0-2.3) to 5.0 (3.3-7.7) (p for trend across grades <.001 for both outcomes). Adjustment for cardiovascular risk factors did not substantially change the associations. The index improved mortality risk classification over demographics and risk factors in participants who did not die during the follow-up. Including in the index the aortic ultrasound and the brain magnetic resonance imaging further improved risk classification.

CONCLUSIONS: Older adults with minimal subclinical vascular disease had low cardiovascular events risk and mortality. This approach might more fully account for vascular burden.

}, keywords = {Aged, Aged, 80 and over, Cardiovascular Diseases, Cost of Illness, Female, Humans, Male, Risk, Vascular Diseases}, issn = {1758-535X}, doi = {10.1093/gerona/glr069}, author = {Inzitari, Marco and Arnold, Alice M and Patel, Kushang V and Mercer, Laina D and Karlamangla, Arun and Ding, Jingzhong and Psaty, Bruce M and Williamson, Jeff D and Kuller, Lewis H and Newman, Anne B} }