Major Depression More Than Doubles Risk of Dementia Among Adults With Diabetes

ScienceDaily (Mar. 8, 2010) — Adults who have both diabetes and major depression are more than twice as likely to develop dementia, compared to adults with diabetes only, according to a study published in the recent Journal of General Internal Medicine.

Dementia is the progressive decline of thinking and reasoning abilities. These can include memory loss, difficulty with basic math, wandering, living in the past, personality changes, and not recognizing familiar people.

"Diabetes alone has shown to be a risk factor for dementia, as has major depression by itself," noted the lead author of the study, Dr. Wayne Katon, University of Washington (UW) professor of psychiatry and behavioral sciences. Also on the study team were researchers from the Group Health Research Institute in Seattle and the Veterans Affairs (VA) Puget Sound Health Care System, as well as UW researchers in medicine and in epidemiology.

Various other population studies, Katon and the other authors noted, have shown that the risk of Alzheimer's disease, vascular dementia, and other types of dementia is from 40 percent to 100 percent higher in people with diabetes, compared to people without diabetes. A history of depression more than doubles the subsequent risk of Alzheimer's disease and other forms of dementia in the general population.

"We wanted to determine the effects of both conditions -- diabetes and major depression--occurring together," Katon said. "Our analysis suggests that major depression more than doubles the risk of dementia in adults with diabetes."

The research team on this project, which is part of the Pathways Epidemiological Follow-Up Study, tracked the outcomes of adults from the Group Health Cooperative's diabetes registry who agreed to participate. They were patients from nine Puget Sound area primary-care clinics in western Washington state. The clinics were chosen for their socioeconomic and racial/ethnic diversity and were demographically similar to the area's population. Initial enrollment of patients took place between 2000 and 2002, and the patients were studied for five years. Patients already diagnosed with dementia were excluded from the study.

Over the five-year period, 36 of 455, or 7.9 percent, of the diabetes patients with major depression were diagnosed with dementia. Among the 3,382 patients with diabetes alone, 163 or 4.8 percent developed dementia.

The researchers calculated that major depression with diabetes was associated with a 2.7-fold increase of dementia, compared to diabetes alone. Because the onset of dementia can sometimes be marked by depression, the researchers also adjusted their hazard model to exclude patients who developed dementia in the first two years after their depression diagnosis.

The team's previous findings from earlier studies showed that depression increases the mortality rate among people with diabetes, as well as the rate of complications such as heart, blood vessel, kidney and vision problems.

The exact manner in which diabetes and depression interact to result in poorer outcomes is not certain. Some studies suggest that a genetic marker for dementia is associated with a faster cognitive decline. Depression may also raise the risk of dementia, the authors noted, because of biological abnormalities linked to this affective illness, including high levels of the stress hormone cortisol, poor regulation in the hypothalamus-pituitary system, or autonomic nervous system problems that can affect heart rate, blood clotting, and inflammatory responses.

Depression, they added, might also raise the risk of dementia because of behaviors common in the condition, such as smoking, over-eating, lack of exercise, and difficulty in adhering to medication and treatment regimens. In the current study, patients with both diabetes and major depression were more likely to be female, single, smokers, physically inactive, and treated with insulin. They also had more diabetes complications and a higher body mass index, a ratio calculated from height and weight. However, these differences were controlled for in the analysis and depression remained an important risk factor.

Diabetes, the authors noted, is a risk factor for dementia because of blood vessel problems and also may accelerate the decline of Alzheimer's disease. Many factors linked to diabetes might also increase the odds of developing dementia, including tissue damage from high blood sugar levels, episodes of low blood sugar and insulin resistance.

Depression is common among people who have diabetes. Until more research is available on the exact mechanisms behind the links between depression, diabetes, and dementia, the researchers say, "It seems prudent for clinicians to add effective screening and treatment for depression to other preventive measures such as exercise, weight control, and blood sugar control to protect against the development of cognitive deficits in patients with diabetes."

In addition to Katon, members of the research team were Elizabeth H.B. Lin, Evette Ludman, Carolyn Rutter, Malia Oliver and Michael Von Korff, all from the Group Health Research Institute; Lisa Williams from the UW Department of Medicine and the Epidemiologic Research and Information Center at the VA Puget Sound Health Care System; Paul Ciechanowski from the UW Department of Psychiatry and Behavioral Sciences; Susan R. Heckbert, from the Department of Epidemiology in the UW School of Public Health; and Paul K. Krane from the UW Department of Medicine.

Grants from the National Institute of Mental Health, National Institutes of Health, supported the study.

Various forms of headache, properly called headache disorders, are among the most common disorders of the nervous system. They are pandemic and, in many cases, life-long conditions.

Headache itself is a painful and often disabling feature of a relatively small number of primary headache disorders. It also occurs secondarily to a considerable number of other conditions. A wide range of headache types have been classified in detail by the International Headache Society (table I). The most common among them – tension-type headache (TTH), migraine, cluster headache and the so-called chronic daily headache syndromes – cause substantial levels of disability. Headache has been and continues to be underestimated in scope and scale, and headache disorders remain under-recognized and under-treated throughout the world.

A worldwide problem

Although the epidemiology of headache disorders is only partly documented, taken together, headache disorders are extraordinarily common. Population-based studies have mostly focused on migraine which, although the most frequently studied, is not the most common headache disorder. Other types of headache, such as the more prevalent TTH and sub-types of the more disabling chronic daily headache, have received less attention. Few population-based studies exist for developing countries where limited funding and large and often rural populations, coupled with the low profile of headache disorders compared with other diseases, prevent the systematic collection of information.

In developed countries, Tension Type Headache (TTH) alone affects two-thirds of adult males and over 80% of females. Extrapolation from figures for migraine prevalence and attack incidence suggests that 3000 migraine attacks occur every day for each million of the general population. Less well recognized is the toll of chronic daily headache: up to one adult in 20 has headache every or nearly every day.

Not only is headache painful, but headache disorders are also disabling. Worldwide, according to the World Health Organization (WHO), migraine alone is 19th among all causes of years lived with disability (YLDs). Headache disorders impose recognizable burden on sufferers including sometimes substantial personal suffering, impaired quality of life and financial cost. Repeated headache attacks, and often the constant fear of the next one, damage family life, social life and employment. For example, social activity and work capacity are reduced in almost all migraine sufferers and in 60% of TTH sufferers.

The long-term effort of coping with a chronic headache disorder may also predispose the individual to other illnesses. For example, depression is three times more common in people with migraine or severe headaches than in healthy individuals.

http://www.who.int/mediacentre/factsheets/fs277/en/print.html

Mental health and human rights

People with mental disorders are some of the most neglected people in the world. In many communities, mental illness is not considered a real medical condition, but viewed as a weakness of character or as a punishment for immoral behaviour. Even when people with mental disorders are recognized as having a medical condition, the treatment they receive is often less than humane.

Human rights violations against people with mental disorders occur in communities throughout the world – in mental health institutions, hospitals, and in the wider community

http://www.who.int/features/2005/mental_health/en/index.html

 Mental health

 Mental health is not just the absence of mental disorder. It is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.

In most countries, particularly low- and middle-income countries, mental health services are severely short of resources - both human and financial. Of the health care resources available, most are currently spent on the specialized treatment and care of the people with mental illness, and to a lesser extent on an integrated mental health system. Instead of providing care in large psychiatric hospitals, countries should integrate mental health into primary health care, provide mental health care in general hospitals and develop community-based mental health services.

Even less funding is available for mental health promotion, an umbrella term that covers a variety of strategies, all aimed at having a positive effect on mental health well-being in general. The encouragement of individual resources and skills, and improvements in the socio-economic environment are among the strategies used.

Mental health promotion requires multi-sectoral action, involving a number of government sectors and non-governmental or community-based organizations. The focus should be on promoting mental health throughout the lifespan to ensure a healthy start in life for children and to prevent mental disorders in adulthood and old age.