Associations between depression and anxiety in midlife and dementia more than 30 years later: The HUNT Study

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Post stroke depression(33% chance).

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Associations between depression and anxiety in midlife and dementia more than 30 years later: The HUNT Study

Ragnhild Holmberg Aunsmo, Bjørn Heine Strand, Kaarin J. Anstey, Sverre Bergh, Mika Kivimäki, Sebastian Köhler, Steinar Krokstad, Gill Livingston, Fiona E. Matthews, Geir Selbæk

First published: 28 November 2024

https://doi.org/10.1002/dad2.70036

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Abstract

INTRODUCTION

It is unclear how midlife depression and anxiety affect dementia risk. We examined this in a Norwegian cohort followed for 30 years.

METHODS

Dementia status at age 70+ in the fourth wave of the Trøndelag Health Study (HUNT4, 2017–2019, N = 9745) was linked with anxiety and depression from HUNT1 (1984–1985), HUNT2 (1995–1997), HUNT3 (2006–2008), and HUNT4. Longitudinal anxiety and depression score, and prevalence trajectories during 1984–2019 by dementia status at HUNT4 were fitted using mixed effects regression adjusting for age, sex, education, and lifestyle and health factors.

RESULTS

Dementia at HUNT4 was associated with higher case prevalence at all waves, from 1.9 percentage points (pp) (95% CI: 0.1–3.7) higher at HUNT1 to 7.6 pp (95% CI: 5.7–9.6) higher at HUNT4.

DISCUSSION

Our findings show that depression and anxiety was more common more than 30 years before dementia onset in those who later developed dementia.

Highlights

• Older individuals with dementia had a higher prevalence of mixed anxiety- and depressive symptoms (A + D), both concurrently with and more than three decades prior to their dementia diagnosis.
• Older individuals with dementia had higher levels of anxiety, both concurrently and up to two decades prior to their dementia diagnosis.
• Depressive symptoms increased by time among those who developed dementia, but not among others.
• Results were similar for all cause dementia, Alzheimer's disease, and other types of dementia; however, for vascular dementia, the difference was not significant until dementia was present.

1 BACKGROUND

Lowering risk of dementia is of increasing importance in the future with the aging population.

The Lancet Commission on Dementia Prevention, intervention and Care estimated that 3% of dementia cases are attributable to depression, one of the 12 common modifiable risk factors that, assuming causality, jointly account for 40% of dementia cases.¹ Depression is a major contributor to the burden of disease. Globally, 5% of all adults and 6% of adults 60 years and older are affected by depression.² The burden of depression and anxiety disorders increased by more than 25% in 2020, during the coronavirus disease 2019 (COVID-19) pandemic.³

In studies of older people, the evidence consistently shows increased incidence of dementia during the initial years after depression assessment.^4-8 Some studies have found an association between dementia and depression symptoms manifesting more than 10 years prior to dementia diagnosis,^{7, 9} whereas other studies show no such long-term associations.^{10, 11} The evidence is mixed regarding whether depression before the age of 65 years is associated with increased risk of dementia in later life,^12-15 whether treatment of depression can reduce the risk,¹⁶ and whether recovery from depression might attenuate¹⁴ or even remove the excess risk.¹⁷ Evidence on the relationship between depression and subtypes of dementia is also mixed: although some studies report an association between depression and Alzheimer's disease (AD),⁶ others have found that depression was more strongly associated with vascular dementia (VaD) than AD,^{18, 19} and the association remained for VaD—but not for AD—when depression was assessed more than 20 years before dementia diagnosis.⁷

Depression and anxiety frequently co-occur.²⁰ Several studies have reported that anxiety is associated with an increased risk of dementia,^{13, 21-23} although a recent meta-analysis found no overall association between anxiety and dementia.²⁴ In addition, the sum of anxiety and depressive symptoms in midlife has been linked to increased risk of dementia²⁵ and death related to dementia.²⁶

In this analysis of a prospective population-based cohort study of Norwegian adults, we aimed to investigate whether depression, anxiety, and the prevalence of clinical relevant sum of anxiety- and depressive symptoms (A + D), as assessed up to 33 years before dementia diagnosis, were more common among individuals who later developed dementia compared to those who did not. Furthermore, we aimed to clarify whether the pattern was similar for all-cause dementia, AD, VaD, and other dementias, and for men and women. We hypothesized that midlife A + D, depression, and anxiety were associated with an increased risk of dementia in later life, with stronger associations observed nearer to the dementia diagnosis.

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