Depression or Anxiety May Lead to Earlier Onset of Alzheimer’s Disease
Presenter: Emily Eijansantos
Depression has been established as a risk factor in AD that may accelerate the development and disease course. Increased symptoms of anxiety in patients with AD have been associated with increased symptoms, earlier age of onset, and more rapid cognitive decline. Posttraumatic stress disorder (PTSD) also appears to confer a greater risk for dementia.
“More research is needed to understand the impact of other psychiatric disorders on the development of AD and whether treatment and management could help prevent or delay the onset of dementia for susceptible patients,” said Emily Eijansantos of the University of California, San Francisco.
Researchers screened 1,500 AD patients from the UCSF Memory and Aging Center for history of psychiatric disorders, including depression, anxiety, bipolar disorder, PTSD, and schizophrenia; 43% had a history of depression, 32% had anxiety, 1.2% bipolar disorder, 1% PTSD, and 0.4% schizophrenia.
AD patients with depression experienced dementia symptoms 2.1 years earlier than those who did not have depression. Those with anxiety started experiencing dementia symptoms 3 years earlier than those with no anxiety.
With each additional psychiatric disorder diagnosis, the age of onset of AD symptoms doubled. Patients with only one psychiatric disorder developed symptoms 1.5 years before those with no psychiatric disorder. A history of two psychiatric disorders led to the development of symptoms 3.3 years earlier than those with no psychiatric disorders. Three or more psychiatric disorders produced a 7.3 year reduction in age of onset.
In addition to screening for a history of these five psychiatric disorders, the researchers also looked at the interactions between psychiatric disease and other typical AD risk factors, including hypertension, hyperlipidemia, diabetes, education, and APOE4 status, as well as novel AD-associated factors such as left-handedness, learning disabilities, autoimmune diseases, and seizure history. Their results show AD patients with comorbid depression or anxiety appeared to be more likely to be female and have a younger age at onset, and to possess fewer amounts of typical AD risk factors. Patients with depression were more likely to have an autoimmune disease and those with anxiety were more likely to have a history of seizures.
“While this association between depression and autoimmune disease, and seizures and anxiety, is quite preliminary, we hypothesize that the presentation of depression in some patients could possibly reflect a greater burden of neuroinflammation,” said Eijansantos. “The presence of anxiety might indicate a greater degree of neuronal hyperexcitability, potentially opening up new therapeutic targets for dementia prevention.”
A limitation of the study is that the data was obtained from a tertiary specialty memory care center and retrospective chart review.
“Certainly this isn’t to say that patients with depression and anxiety will necessarily develop AD, but healthcare providers might consider discussing ways to promote long-term brain health with patients with these conditions,” said Eijansantos.
Link to abstract: History of Psychiatric Disease Inversely Correlates with Age of Onset in Alzheimer’s Disease
Emily Eijansantos reported nothing to disclose.