Depression with mild cognitive impairment (MCI) may be associated with a high risk of dementia. Likewise, anemia and subcortical ischemic changes might be associated with depression in the elderly individuals. We examined the relationship between anemia, subcortical ischemic changes, and depressive symptoms in 388 elderly patients with MCI (74.0% women, mean age = 71.8) who were evaluated at the Clinical Research Center for Dementia of South Korea. Blood samples were drawn from all consenting participants and depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS-15). We also evaluated the severity of white matter hyperintensities (WMH) on brain using magnetic resonance imaging (MRI). After a multivariable adjustment, we found no significant differences in GDS-15 score between anemic and nonanemic groups (F = 3.0, P = .085) and among WMH level groups (F = 0.6, P = .574) independently. However, the interaction between anemia and the severity of WMH was significantly associated with depressive symptoms (analysis of covariance, F = 7.8, P < .001). In post hoc tests, a higher depressive symptom score was observed in anemic participants with severe WMH. Anemia with severe subcortical ischemic changes appears to be related to depressive symptoms in patients with MCI.
RitchieKTouchonJ. Mild cognitive impairment: conceptual basis and current nosological status. Lancet. 2000;355(9199):225–228.
2.
PetersenRCRobertsROKnopmanDSBoeveBFGedaYEIvnikRJ. Mild cognitive impairment: ten years later. Arch Neurol. 2009;66(12):1447–1455.
3.
LyketsosCGLopezOJonesBFitzpatrickALBreitnerJDeKoskyS. Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study. JAMA. 2002;288(12):1475–1483.
4.
GreenRCCupplesLAKurzAAuerbachSGoRSadovnickD. Depression as a risk factor for Alzheimer disease: the MIRAGE Study. Arch Neurol. 2003;60(5):753–759.
5.
SaczynskiJSBeiserASeshadriSAuerbachSWolfPAAuR. Depressive symptoms and risk of dementia: the Framingham Heart Study. Neurology. 2010;75(1):35–41.
6.
OwnbyRLCroccoEAcevedoAJohnVLoewensteinD. Depression and risk for Alzheimer disease: systematic review, meta-analysis, and metaregression analysis. Arch Gen Psychiatry. 2006;63(5):530–538.
7.
ModregoPJFerrandezJ. Depression in patients with mild cognitive impairment increases the risk of developing dementia of Alzheimer type: a prospective cohort study. Arch Neurol. 2004;61(8):1290–1293.
8.
SteffensDCKrishnanKRCrumpCBurkeGL. Cerebrovascular disease and evolution of depressive symptoms in the cardiovascular health study. Stroke. 2002;33(6):1636–1644.
9.
de GrootJCde LeeuwFEOudkerkMHofmanAJollesJBretelerMM. Cerebral white matter lesions and depressive symptoms in elderly adults. Arch Gen Psychiatry. 2000;57(11):1071–1076.
10.
LavretskyHRoybalDJBallmaierMTogaAWKumarA. Antidepressant exposure may protect against decrement in frontal gray matter volumes in geriatric depression. J Clin Psychiatry. 2005;66(8):964–967.
11.
LavretskyHZhengLWeinerMWMungasDReedBKramerJH. Association of depressed mood and mortality in older adults with and without cognitive impairment in a prospective naturalistic study. Am J Psychiatry. 2010;167(5):589–597.
12.
SchoeversRAGeerlingsMIDeegDJHolwerdaTJJonkerCBeekmanAT. Depression and excess mortality: evidence for a dose response relation in community living elderly. Int J Geriatr Psychiatry. 2009;24(2):169–176.
13.
InzitariMStudenskiSRosanoCZakaiNALongstrethWTJrCushmanM. Anemia is associated with the progression of white matter disease in older adults with high blood pressure: the cardiovascular health study. J Am Geriatr Soc. 2008;56(10):1867–1872.
14.
PenninxBWPahorMCesariMCorsiAMWoodmanRCBandinelliS. Anemia is associated with disability and decreased physical performance and muscle strength in the elderly. J Am Geriatr Soc. 2004;52(5):719–724.
15.
DealJACarlsonMCXueQLFriedLPChavesPHM. Anemia and 9-year domain-specific cognitive decline in community-dwelling older women: the women’s health and aging study II. J Am Geriatr Soc. 2009;57(9):1604–1611.
16.
OnderGPenninxBWCesariMBandinelliSLauretaniFBartaliB. Anemia is associated with depression in older adults: results from the InCHIANTI study. J Gerontol A Biol Sci Med Sci. 2005;60(9):1168–1172.
17.
LuccaUTettamantiMMosconiPApoloneGGandiniFNobiliA. Association of mild anemia with cognitive, functional, mood and quality of life outcomes in the elderly: the “Health and Anemia” study. PLoS One. 2008;3(4):e1920.
MorrisJC. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology. 1993;43(11):2412–2414.
20.
KangYNaDLHanhnS. A validity study on the Korean Mini-Mental State Examination (K-MMSE) in dementia patients. J Korean Neurol Assoc. 1997;15(2):300–307.
21.
SheikhJIYesavageJAGeriatric Depression Scale (GDS): Recent evidence and development of a shorter version. In: BrinkTL (Ed.), Clinical Gerontology: A Guide to Assessment and Intervention. New York, NY: Haworth Press Inc; 1986:165–173.
22.
AhnHJChinJParkALeeBHSuhMKSeoSW. Seoul Neuropsychological Screening Battery-Dementia Version (SNSB-D): a useful tool for assessing and monitoring cognitive impairments in dementia patients. J Korean Med Sci. 2010;25(7):1071–1076.
23.
KangYNaDL. Seoul Neuropsychological Screening Battery (SNSB). Seoul: Human Brain Research & Consulting Co; 2003.
24.
FazekasFChawlukJBAlaviAHurtigHIZimmermanRA. MR signal abnormalities at 1.5 T in Alzheimer’s dementia and normal aging. Am J Roentgenol. 1987;149(2):351–356.
25.
ScheltensPBarkhofFLeysDPruvoJPNautaJJVermerschP. A semiquantative rating scale for the assessment of signal hyperintensities on magnetic resonance imaging. J Neurol Sci. 1993;114(1):7–12.
26.
BarnesDEAlexopoulosGSLopezOLWilliamsonJDYaffeK. Depressive symptoms, vascular disease, and mild cognitive impairment: findings from the Cardiovascular Health Study. Arch Gen Psychiatry. 2006;63(3):273–279.
27.
BlazerDG. Depression in late life: review and commentary. J Gerontol A Biol Sci Med Sci. 2003;58(3):249–265.
28.
AlexopoulosGS. Vascular disease, depression, and dementia. J Am Geriatr Soc. 2003;51(8):1178–1180.
29.
TettamantiMLuccaUGandiniFRecchiaAMosconiPApoloneG. Prevalence, incidence and types of mild anemia in the elderly: the “Health and Anemia” population-based study. Haematologica. 2010;95(11):1849–1856.
30.
IshineMWadaTAkamatsuKCruzMRSakagamiTKitaT. No positive correlation between anemia and disability in older people in Japan. J Am Geriatr Soc. 2005;53(4):733–734.
OdaKOkuboYIshidaRMurataYOhtaKMatsudaT. Regional cerebral blood flow in depressed patients with white matter magnetic resonance hyperintensity. Biol Psychiatry. 2003;53(2):150–156.
33.
BakkerSLde LeeuwFEde GrootJCHofmanAKoudstaalPJBretelerMM. Cerebral vasomotor reactivity and cerebral white matter lesions in the elderly. Neurology. 1999;52(3):578–583.
34.
VorstrupS. Tomographic cerebral blood flow measurements in patients with ischemic cerebrovascular disease and evaluation of the vasodilatory capacity by the acetazolamide test. Acta Neurol Scand Suppl. 1988;114:1–48.
35.
MatsuoKOnoderaYHamamotoTMurakiKKatoNKatoT. Hypofrontality and microvascular dysregulation in remitted late-onset depression assessed by functional near-infrared spectroscopy. Neuroimage. 2005;26(1):234–242.
36.
KuwabaraYSasakiMHirakataHKogaHNakagawaMChenT. Cerebral blood flow and vasodilatory capacity in anemia secondary to chronic renal failure. Kidney Int. 2002;61(2):564–569.
37.
MitracheCPasswegJRLiburaJPetrikkosLSeilerWOGratwohlA. Anemia: an indicator for malnutrition in the elderly. Ann Hematol. 2001;80(5):295–298.
