Chronic Systemic Inflammation Is Associated With Symptoms of Late-Life Depression: The ARIC Study

Natalia Sonsin-Diaz, Rebecca F. Gottesman, Elizabeth Fracica, Jeremy Walston, B. Gwen Windham, David S Knopman, Keenan A. Walker

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Abstract

Objective: The current study examined how the pattern of systemic inflammation in the decades leading up to late-life relates to depression symptoms in older adults. Methods: Within the Atherosclerosis Risk in Communities Study, we measured high-sensitivity C-reactive protein (CRP), a nonspecific marker of systemic inflammation, at three visits: 21 years and 14 years before, and concurrent with the assessment of depression symptoms, defined using the 11-item Center for Epidemiologic Studies Depression (CESD) scale. We categorized participants into one of four groups based on their 21-year longitudinal pattern of elevated (≥3 mg/L) versus low (<3 mg/L) CRP (stable low; unstable low; unstable elevated; stable elevated). Analyses excluded participants with suspected depression during midlife. Results: A total of 4,614 participants were included (age at CESD assessment: 75.5 [SD: 5.1]; 59% female; follow-up time: 20.7 years [SD: 1.0]). Compared to participants who maintained low CRP levels (stable low), participants who had elevated CRP at two of three visits (unstable elevated; ß = 0.09; 95% confidence interval [CI]: 0.02, 0.17) and participants who maintained elevated CRP at all three visits (stable elevated; ß = 0.13; 95% CI: 0.05, 0.21) had greater depression symptoms as older adults, after adjusting for confounders. After excluding participants with late-life cognitive impairment, only participants with stable elevated CRP demonstrated significantly greater late-life depression symptoms. In a secondary analysis, stable elevated CRP was associated with increased risk for clinically significant late-life depression symptoms. Conclusion: Chronic or repeated inflammation in the decades leading up to older adulthood is associated with late-life depression, even in the context of normal cognition.

Original languageEnglish (US)
JournalAmerican Journal of Geriatric Psychiatry
DOIs
StatePublished - Jan 1 2019

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C-Reactive Protein
Depression
Inflammation
Epidemiologic Studies
Confidence Intervals
Symptom Assessment
Cognition
Atherosclerosis

Keywords

  • cognition
  • dementia
  • depression
  • immunology
  • Inflammation

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Psychiatry and Mental health

Cite this

Chronic Systemic Inflammation Is Associated With Symptoms of Late-Life Depression : The ARIC Study. / Sonsin-Diaz, Natalia; Gottesman, Rebecca F.; Fracica, Elizabeth; Walston, Jeremy; Windham, B. Gwen; Knopman, David S; Walker, Keenan A.

In: American Journal of Geriatric Psychiatry, 01.01.2019.

Research output: Contribution to journalArticle

Sonsin-Diaz, Natalia ; Gottesman, Rebecca F. ; Fracica, Elizabeth ; Walston, Jeremy ; Windham, B. Gwen ; Knopman, David S ; Walker, Keenan A. / Chronic Systemic Inflammation Is Associated With Symptoms of Late-Life Depression : The ARIC Study. In: American Journal of Geriatric Psychiatry. 2019.
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abstract = "Objective: The current study examined how the pattern of systemic inflammation in the decades leading up to late-life relates to depression symptoms in older adults. Methods: Within the Atherosclerosis Risk in Communities Study, we measured high-sensitivity C-reactive protein (CRP), a nonspecific marker of systemic inflammation, at three visits: 21 years and 14 years before, and concurrent with the assessment of depression symptoms, defined using the 11-item Center for Epidemiologic Studies Depression (CESD) scale. We categorized participants into one of four groups based on their 21-year longitudinal pattern of elevated (≥3 mg/L) versus low (<3 mg/L) CRP (stable low; unstable low; unstable elevated; stable elevated). Analyses excluded participants with suspected depression during midlife. Results: A total of 4,614 participants were included (age at CESD assessment: 75.5 [SD: 5.1]; 59{\%} female; follow-up time: 20.7 years [SD: 1.0]). Compared to participants who maintained low CRP levels (stable low), participants who had elevated CRP at two of three visits (unstable elevated; {\ss} = 0.09; 95{\%} confidence interval [CI]: 0.02, 0.17) and participants who maintained elevated CRP at all three visits (stable elevated; {\ss} = 0.13; 95{\%} CI: 0.05, 0.21) had greater depression symptoms as older adults, after adjusting for confounders. After excluding participants with late-life cognitive impairment, only participants with stable elevated CRP demonstrated significantly greater late-life depression symptoms. In a secondary analysis, stable elevated CRP was associated with increased risk for clinically significant late-life depression symptoms. Conclusion: Chronic or repeated inflammation in the decades leading up to older adulthood is associated with late-life depression, even in the context of normal cognition.",
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AU - Sonsin-Diaz, Natalia

AU - Gottesman, Rebecca F.

AU - Fracica, Elizabeth

AU - Walston, Jeremy

AU - Windham, B. Gwen

AU - Knopman, David S

AU - Walker, Keenan A.

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AB - Objective: The current study examined how the pattern of systemic inflammation in the decades leading up to late-life relates to depression symptoms in older adults. Methods: Within the Atherosclerosis Risk in Communities Study, we measured high-sensitivity C-reactive protein (CRP), a nonspecific marker of systemic inflammation, at three visits: 21 years and 14 years before, and concurrent with the assessment of depression symptoms, defined using the 11-item Center for Epidemiologic Studies Depression (CESD) scale. We categorized participants into one of four groups based on their 21-year longitudinal pattern of elevated (≥3 mg/L) versus low (<3 mg/L) CRP (stable low; unstable low; unstable elevated; stable elevated). Analyses excluded participants with suspected depression during midlife. Results: A total of 4,614 participants were included (age at CESD assessment: 75.5 [SD: 5.1]; 59% female; follow-up time: 20.7 years [SD: 1.0]). Compared to participants who maintained low CRP levels (stable low), participants who had elevated CRP at two of three visits (unstable elevated; ß = 0.09; 95% confidence interval [CI]: 0.02, 0.17) and participants who maintained elevated CRP at all three visits (stable elevated; ß = 0.13; 95% CI: 0.05, 0.21) had greater depression symptoms as older adults, after adjusting for confounders. After excluding participants with late-life cognitive impairment, only participants with stable elevated CRP demonstrated significantly greater late-life depression symptoms. In a secondary analysis, stable elevated CRP was associated with increased risk for clinically significant late-life depression symptoms. Conclusion: Chronic or repeated inflammation in the decades leading up to older adulthood is associated with late-life depression, even in the context of normal cognition.

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KW - dementia

KW - depression

KW - immunology

KW - Inflammation

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