Increase in Number of Depression Symptoms Over Time is Related to Worse Cognitive Outcomes in Older Adults With Type 2 Diabetes

Ramit Ravona-Springer*, Anthony Heymann, Hung Mo Lin, Xiaoyu Liu, Yuval Berman, Jonathan Schwartz, Laili Soleimani, Mary Sano, Michal Schnaider Beeri

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Objective: Older adults with type 2 diabetes (T2D) are at increased risk for depression, cognitive decline, and dementia compared to those without T2D. Little is known about the association of simultaneous changes in depression symptoms and cognitive decline over time. Methods: Subjects (n=1021; mean age 71.6 [SD=4.6]; 41.2% female) were initially cognitively normal participants of the Israel Diabetes and Cognitive Decline study who underwent evaluations of depression and cognition approximately every 18 months. Cognitive tests were summarized into four cognitive domains: episodic memory, attention/working memory, executive functions, and semantic categorization. The average of the z-scores of the four domains defined global cognition. Depression symptoms were assessed using the Geriatric Depression Scale, 15-item version. We fit a random coefficients model of changes in depression and in cognitive functions, adjusting for baseline sociodemographic and cardiovascular variables. Results: Higher number of depression symptoms at baseline was significantly associated with lower baseline cognitive scores in global cognition (estimate = −0.1175, SE = 0.021, DF = 1,014, t = −5.59; p < 0.001), executive functions (estimate = −0.186, SE = 0.036, DF = 1,013, t = −5.15; p = <0.001), semantic categorization (estimate = −0.155, SE = 0.029, DF = 1,008, t = −5.3; p < 0.001), and episodic memory (estimate = −0.08165, SE = 0.027, DF = 1,035, t = −2.92; p = 0.0036), but not with rate of decline in any cognitive domain. During follow-up, a larger increase in number of depression symptoms, was associated with worse cognitive outcomes in global cognition (estimate = −0.1053, SE = 0.027, DF = 1,612, t = −3.77; p = 0.0002), semantic categorization (estimate = −0.123, SE = 0.036, DF = 1,583, t = −3.36; p = 0.0008), and in episodic memory (estimate = −0.165, SE = 0.055, DF = 1,622, t = −3.02; p = 0.003), but the size of this effect was constant over time. Conclusion: In elderly with T2D, increase in depression symptoms over time is associated with parallel cognitive decline, indicating that the natural course of the two conditions progresses concurrently and suggesting common underlying mechanisms".

Original languageEnglish
Pages (from-to)1-11
Number of pages11
JournalAmerican Journal of Geriatric Psychiatry
Issue number1
StatePublished - Jan 2021


FundersFunder number
LeRoy Schecter Foundation
National Institute on AgingP30AG066514, P50 AG05138, R01 AG034087
Helen Bader Foundation


    • Trajectories
    • cognition
    • depression
    • older adults
    • type 2 diabetes


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