Estimating associations between antidepressant use and incident mild cognitive impairment in older adults with depression
Open Access
- 17 January 2020
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 15 (1), e0227924
- https://doi.org/10.1371/journal.pone.0227924
Abstract
Previous studies have provided equivocal evidence of antidepressant use on subsequent cognitive impairment; this could be due to inconsistent modeling approaches. Our goals are methodological and clinical. We evaluate the impact of statistical modeling approaches on the associations between antidepressant use and risk of Mild Cognitive Impairment (MCI) in older adults with depression. 716 participants were enrolled. Our primary analysis employed a time-dependent Cox proportional hazards model. We also implemented two fixed-covariate proportional hazards models—one based on having ever used antidepressants during follow-up, and the other restricted to baseline use only. Treating antidepressant use as a time-varying covariate, we found no significant association with incident MCI (HR = 0.92, 95% CI: 0.70, 1.20). In contrast, when antidepressant use was treated as a fixed covariate, we observed a significant association between having ever used antidepressants and lower risk of MCI (HR = 0.40, 95% CI: 0.28, 0.56). However, in the baseline-use only model, the association was non-significant (HR = 0.84, 95% CI: 0.60, 1.17). Our results were dependent upon statistical models and suggest that antidepressant use should be modeled as a time-varying covariate. Using a robust time-dependent analysis, antidepressant use was not significantly associated with incident MCI among cognitively normal persons with depression.This publication has 38 references indexed in Scilit:
- Antidepressant Use and Cognitive Functioning in Older Medical Patients With Major or Minor DepressionJournal of Clinical Psychopharmacology, 2011
- The increasing burden of depressionNeuropsychiatric Disease and Treatment, 2011
- The APOE ε4 Allele Is Associated with Incident Mild Cognitive Impairment among Community-Dwelling Older PersonsNeuroepidemiology, 2009
- Antidepressants and dementiaJournal of Affective Disorders, 2009
- The National Alzheimer's Coordinating Center (NACC) Database: The Uniform Data SetAlzheimer Disease & Associated Disorders, 2007
- Mild Cognitive Impairment as a Clinical Entity and Treatment TargetArchives of Neurology, 2005
- Mild cognitive impairment as a diagnostic entityJournal of Internal Medicine, 2004
- Screening for late life depression: cut‐off scores for the Geriatric Depression Scale and the Cornell Scale for Depression in Dementia among Japanese subjectsInternational Journal of Geriatric Psychiatry, 2003
- Gene Dose of Apolipoprotein E Type 4 Allele and the Risk of Alzheimer's Disease in Late Onset FamiliesScience, 1993
- Partial residuals for the proportional hazards regression modelBiometrika, 1982