Specific affective dimensions are associated with a faster rate of cognitive decline in older adults

Abstract

AbstractBackgroundThe relationship between different affective presentations and cognitive outcome is poorly understood and may elucidate subgroups of patients who are more at risk for decline. Here we utilized longitudinal data from subjects ≥ 60 years, enrolled in the National Alzheimer’s Coordinating Center (NACC) study for an average of 5 years and who were not demented at baseline to investigate the relationship between affective dimensions and global cognition and specific cognitive domains over time.MethodSubjects [n=17,385; mean age= 73.73 (SD= 7.72); 59.20% female] completed the 15‐item geriatric depression scale (GDS‐15) and a broad neuropsychological battery at baseline, and approximately every 12 month follow ups. Cognitive domains included episodic memory, attention, executive functions, and language. Global cognition averaged the z‐scores of the four domains. Affective dimensions were defined based on GDS‐15 factors previously described, and included dysphoric mood, Withdrawal‐Apathy –Vigor (WAV) , anxiety, hopelessness and memory complaint. Linear mixed models (LMM) analysis was used to assess associations between the five affective dimensions with global cognition and each cognitive domain. Analyses adjusted for baseline age, sex, race/ethnicity, years of education, baseline Functional Assessment Questionnaire (FAQ), indicators for history of diabetes, hypertension, and hypercholesterolemia.ResultAt baseline, our sample had low reported depressive symptoms (GDS‐15=1.66; SD= 2.23) and were non‐demented (MMSE= 28.34; SD=2.01). Reported subjective memory complaint and hopelessness were associated with faster decline in all cognitive domains (all p<0.001) and , attention and executive function (all p<0.001), but not with episodic memory or language. In contrast, dysphoria and anxiety were not associated with a faster decline in global cognition or any of the cognitive domains.ConclusionIn our large clinical sample of initially non‐demented older adults, different affective dimensions had different degree of associations with the rate of cognitive decline, suggesting distinct pathophysiology and need for more targeted interventions.