Prospective Cohort Study of 1-Year Incidence of Cognitive Impairment in Patients with Elderly Depression at Psychiatric Outpatient Unit, Ramathibodi Hospital
Objective : To study incidence of cognitive impairment among elderly patients with depression
during one year and the factors that associated with cognitive impairment of elderly patients
Method : This prospective cohort study was conducted in 87 elderly patients with depression.
The research instrument includes demographic and depression data, Hamilton Rating Scale
for Depression (HAMD-17), Mini-Cognitive Assessment Instrument (Mini-Cog), AD-8 and
Montreal Cognitive Assessment (MoCA) or Montreal Cognitive Assessment-Basic (MoCA-B).
Data were then analyzed in term of descriptive statistics, chi-square test and independent
Results : Incidence of dementia among elderly patients with depression during one year was
24.1%. Factors associated with dementia included age, family history of psychiatric illness,
age at onset of depression, duration of treatment and the problems in 6 cognitive function
domains. MoCA scores between patients with and without dementia were statistically different;
however, severity of depression assessed with HAMD-17 and AD-8 scores were not statistically
Conclusion : Elderly patients with depression are at risk of dementia and problems with
cognitive function. Continually screening, surveillance and prevention of dementia should be
conducted among elderly patients with depression.
Boukeaw P, Teungfung R. Health care and health status of thai aging. Journal of the Association of Researchers 2016; 21: 94-109.
Foundation of Thai Gerontology Research and Development Institute. Situation of the thai elderly 2017. Bangkok:Duantula publisher; 2018.
Department of Mental Health. Clinical Practice Guideline of Psychosocial Intervention for Depressive Disorder for Psychiatric nurse in Tertiary Care. Nonthaburi:Ministry of Public Health; 2011.
Limpawattana P. Reversible dementia. North-Eastern Thai Journal of Neuroscience 2018; 13; 1-10.
Baumgart M, Snyder HM, Carrillo MC, Fazio S, Kim H, Johns H. Summary of the evidence on modifiable risk factors for cognitive decline and dementia: A population-based perspective. Alzheimer & Dement 2015; 11: 718-26.
Muangpisan P. Risk factors of dementia and prevention. [Internet]. 2013 [cited Dec 20, 2019]. Available from: https://www.si.mahidol. ac.th/project/geriatrics/network_title1_4.html
Geda YE, Roberts RO, Mielke MM, Knopman DS, Christianson TJ, Pankratz VS. Baseline neuropsychiatric symptoms and the risk of incident mild cognitive impairment: a population-based study. Am J Psychiatry 2014; 171: 572-81.
Lotrakul M, Sukanich P, Sukying C. The Reliability and Validity of Thai version of Hamilton Rating Scale for Depression. J Psychiatr Assoc Thailand 1996; 41: 235-46.
Kusalaruk P, Nakawiro D. A Validity Study of the Mini-Cog Test in Thai Dementia Patients. Rama Med J 2012; 35:264-71.
Galvin JE, Roe CM, Powlishta KK, Coats MA, Muich SJ, Grant E, et al. The AD8: a brief informant interview to detect dementia. Neurology 2005; 65:559-64.
Hemrungrojn S. Montreal cognitive assessment (MoCA) thai version 2007 [Internet]. 2011[cited Jun 19, 2019] Available from: http://www. mocatest.org/pdf_files/test/MoCATest-Thai.pdf.
Julayanont P, Tangwongchai S, Hemrungrojn S, Tunvirachaisakul C, Phanthumchinda K, Hongsawat J, et al. The Montreal Cognitive Assessment-Basic: A Screening Tool for Mild Cognitive Impairment in Illiterate and Low-Educated Elderly Adults. J Am Geriatr Soc 2015; 63:2550-4.
Muangpisan P. Risk factors of dementia and prevention (Chapter 2) [Internet]. 2013 [cited Dec 20, 2019] Available from: https://www. si.mahidol.ac.th/th/healthdetail.asp?aid=416
Lee GJ, Lu PH, Hua X, Lee S, Wu S, Nguyen K, et al. Depressive symptoms in mild cognitive impairment predict greater atrophy in Alzheimer’s disease-related regions. Biol Psychiatry 2012; 71: 814-21.
Byers LA, Yaffe K. Depression and Risk of Developing Dementia. Nat Rev Neurol 2012; 7: 323–31.
Tsuno N, Homma A. What is the association between depression and Alzheimer’s disease?. Expert Rev Neurother 2009; 9: 1667-76.
Muliyala KP, Varghese M. The complex relationship between depression and dementia. Ann Indian Acad Neurol 2010; 13 (Suppl 2): 69-73.
Green RC, Cupples A, Kurz, Auerbach S, Go R, Sadovnick D, et al. Depression as a Risk Factor for Alzheimer’s Disease: The MIRAGE Study. Arch Neurol 2003; 60: 753-9.
Patramarut K. The prevalence of depression in caregivers of dementia patients at dementia clinic, King Chulalongkorn Memorial hospital [dissertation]. Bangkok: Chulalongkorn University. 2016.
Suwaan A, Takulsitichok S. Prevalence and Factors Associated with Dementia among Elderly in Lukhok Subdistrict, Muang District, Pathumtani Province. APHEIT journal 2016; 5:21-32.
Department of Medical Services. “Dementia” the most found in elderly, female more than male [Internet]. 2015 [cited Dec 20, 2019] Available from: https://www.hfocus.org/ content/2015/04/9712
Geerlings MI, den Heijer T, Koudstaal PJ, Hofman A, Breteler MM. History of depression, depressive symptoms, and medial temporal lobe atrophy and the risk of Alzheimer disease. Neurology 2008; 70:1258–64.
Valkanova V, Ebmeier KP, Allan CL. Depression is linked to dementia in older adults. Practitioner 2017; 261:11-5.
Onyike CU. Psychiatric Aspects of Dementia. Continuum 2016; 22: 600-14.
Phanthachinda K. Dementia. Bangkok: Kobfai publisher; 2000.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Arlington; VA: American Psychiatric Association; 2013