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Patients with coronary artery disease, persistent depression may have greater cognitive decline

Persistent depressive symptoms in some older patients with coronary artery disease may increase their risk for cognitive decline.

Researchers at the University of Calgary, Alberta, Canada, examined the association between depression symptoms and changes in cognitive performance in older patients who have had nonemergency coronary catheterization without prior revascularization. Researchers also examined whether associations between depression symptoms and cognitive decline were influenced by the presence of the apolipoprotein E (APOE) epsilon-4 allele, which is believed to be a genetic risk factor for Alzheimer’s disease.

The study included 350 participants, 60 years or older. Study participants were also recipients of coronary artery bypass graft procedures, percutaneous coronary interventions or medical therapy after catheterization.

Researchers measured a baseline of depressive symptoms and then compared the baseline with a dynamic measure capturing change from baseline to 12 months. They also compared mean change in cognitive scores from baseline to 6, 12, and 30 months, and from 12 to 30 months.

Study models were adjusted for age, gender, educational level and baseline cognitive performance. When compared with participants with no depressive symptoms or baseline-only symptoms, researchers found that participants with persistent depressive symptoms showed significantly greater declines in attention/executive function, learning/memory, verbal fluency and global cognition measures at 30 months (relative to baseline).

Researchers adjusted for sociodemographic and clinical factors and found persistent depressive symptoms were associated with significantly greater declines in all cognitive measures from 12 to 30 months. Researchers also found some evidence of a significantly greater decline in global cognition for participants with persistent depressive symptoms and the presence of APOE epsilon-4 allele (mean Mini-Mental State Examination score change = -2.93; 95% CI, -4.40 to -1.45), but said that further investigation is needed.

“Consequently, a one-time assessment of depressive symptoms may be inadequate for detecting those at risk of longer-term adverse cognitive and functional outcomes,” Elizabeth A. Freiheit MA, of the University of Calgary, and her colleagues wrote. “These findings illustrate the need for longer-term monitoring of depressive symptom severity and change by clinicians and other caregivers.”

Disclosures: This study was supported by the Canadian Institutes of Health Research (CIHR) Institute of Aging, the Medical Services (Alberta) Inc. Foundation, and the Brenda Strafford Foundation Chair in Geriatric Medicine. Ms. Freiheit was supported by a Canadian Cardiovascular Outcomes Research Team doctoral award funded through a CIHR Team Grant in Cardiovascular Outcomes Research. Dr. Maxwell has received salary support from the Alberta Heritage Foundation for Medical Research and from the CIHR Institute of Aging and the Brenda Strafford Foundation Chair in Geriatric Medicine. The researchers reported no relevant financial disclosures.