The complex relationship between depression and progression to incident cognitive impairment across race and ethnicity

Abstract

Introduction: We examined baseline differences in depression and antidepressant use among cognitively normal older adults in five ethnoracial groups and assessed whether depression predicted a faster progression to incident cognitive impairment across groups.

Methods: Data from the National Alzheimer's Coordinating Center (n = 8168) were used to examine differences between non-Hispanic Whites (nHW), African Americans (AA), Hispanics, Asians, and American Indian and Alaskan Natives in cross-sectional and longitudinal models.

Results: AA had a lower risk of depression compared to nHW at baseline. No statistical interactions were noted between ethnoracial groups and depression. However, depression independently predicted a faster progression to incident cognitive impairment. Hispanics and Asian participants had a higher hazard for progression compared to nHW.

Discussion: Previously established risk factors between depression and dementia were not found among AA and nHW participants. The relationship between depression and ethnoracial groups is complex and suggests differential effects on progression from cognitive normality to impairment.

Keywords: Alzheimer's disease; cognitive impairment; depression; disparities; ethnicity; race.

FIGURE 1

Time to incident cognitive impairment using Kaplan‐Meier curves across ethnoracial groups among older adults who were cognitively normal at baseline

FIGURE 2

Examining differences across ethnoracial groups based on Log Hazard (y‐axis) across eight groups and based on depression, apolipoprotein E (APOE) ε4, sex, and age. Hispanic and Black men with APOE ε4+ are less likely to progress compared with non‐Hispanic White men. Women with APOE ε4+ are more likely to progress compared to men across all ethnoracial groups