Depression,non-fatal stroke and all-cause mortality in old age: A prospective cohort study of primary care patients |
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| Authors: | Sebastian Köhler Frans Verhey Siegfried Weyerer Birgitt Wiese Kathrin Heser Michael Wagner Michael Pentzek Angela Fuchs Mirjam Köhler Cadja Bachmann Steffi G Riedel Heller Melanie Luppa Sandra Eifflaender-Gorfer Jochen Werle Horst Bickel Edelgard Mösch Hans-Helmut König Christian Brettschneider Martin Scherer Wolfgang Maier |
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| Institution: | 1. Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University Medical Centre+, Maastricht, The Netherlands;2. Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany;3. Institute of Biometrics, Hannover Medical School, Hannover, Germany;4. Department of Psychiatry, University of Bonn, Bonn, Germany;5. Department of General Practice, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany;6. Institute of Primary Medical Care, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany;g Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany;h Department of Psychiatry, Technical University of Munich, Munich, Germany;i Department of Medical Sociology and Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;j German Center for Neurodegenerative Diseases, Bonn, Germany |
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| Abstract: | BackgroundDepression is a risk factor for stroke and mortality but whether this also holds into old age is uncertain. We therefore studied the association of depression with the risk for non-fatal stroke and all-cause mortality in very old age.MethodsA representative sample of 3085 primary care patients aged ≥75 years were serially assessed during a 6-year follow-up. The relation between depression (Geriatric Depression Scale >6, n=261) and relevant covariates including vascular risk factors and disease, functional and mild cognitive impairment and ApoE genotype on primary care givers information of incident stroke (n=209) and mortality (n=647) were assessed by Cox regression and by competing risk regressions.ResultsDepression was not independently associated with incident stroke in fully adjusted models that treated death as the competing event (subdistribution hazard ratio=0.80, 95% confidence interval=0.47 to 1.36). The risk associated with depression was similar for men and women, and for age groups 75–79, 80–84 and ≥85 years. In contrast, depression increased all-cause mortality rates, even after adjusting for a range of confounders (hazard ratio=1.31, 95% confidence interval=1.03 to 1.67).LimitationsWe have no information on past depressive episodes and cause of death.ConclusionsIn contrast to reports in younger populations, depression does not appear to increase stroke risk among the old and very old, but continuous to be a risk factor for all-cause mortality. |
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| Keywords: | Cerebrovascular accident Depression Epidemiology Prevention Risk factors Mortality |
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