An Idea Whose Time Has Come: Promoting Health Equity by Preventing the Syndemic of Depression and Medical Comorbidity

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 (IDCD) 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 (GDS), 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=1014, t=−5.59; p