Neurological Sciences

https://doi.org/10.1007/s10072-020-04279-8

ORIGINAL ARTICLE

Association of depressive symptoms with decline of cognitive

function—Rugao longevity and ageing study
Zhuoran Hou 1,2 & Xiaofeng Wang 1 & Yuchen Wang 1 & Jiucun Wang 3,2 & Judy Zhong 4

Received: 16 October 2019 / Accepted: 2 February 2020

# Fondazione Società Italiana di Neurologia 2020

Abstract
Cognitive decline is a central feature in the aging process. Previous studies have indicated an association between depressive
symptoms and cognitive decline in Caucasian populations. However, few studies have examined the effect of changes in
depression on the trajectory of cognitive decline. Here, we included 580 participants with normal cognitive ability and complete
cognitive and depression data from the Rugao Longevity and Ageing Study (RuLAS). We explored the relationship between
depressive symptoms and cognitive decline in these participants. We examined how the change in depressive symptoms affected
the trajectory in the HDS-R (the Revised Hasegawa Dementia Scale) scores by comparing cognition function in both the
depression deterioration group and the depression steady group by using a linear mixed model. The results indicated that those
with deteriorating depression tended to have faster cognitive declines than those with steady depression, indicated by the
significance of the interaction term of GDS (Geriatric Depression Scale) groups and time (unadjusted model, β = − 0.673,
p < 0.001). The results remained significant after adding demographic covariates. Moreover, we found that those with the worst
depressive symptoms at baseline had the worst cognition in subsequent years (GDS = 0 group vs. GDS ≥ group in the unadjusted
model: β = − 1.522, p < 0.003), while the slope of change was not significantly different among groups (GDS = 0 group × time
vs. GDS > =4 group × time in the unadjusted model: β = − 0.045, p = 0.857). Therefore, we found that depressive symptom
deterioration was significantly associated with faster cognitive decline. Medical interventions for depression may decrease the
number of older Chinese individuals who experience early-stage cognitive decline.

Keywords Cognitive decline . Older people . Depressive symptoms . Linear mixed model

Abbreviations MCI Mild cognitive impairment

GDS Geriatric Depression Scale BMI Body mass index
HDS-R Revised Hasegawa Dementia Scale

Zhuoran Hou and Xiaofeng Wang contributed equally to this work. Introduction
* Jiucun Wang Cognitive decline is a central feature in the process of aging in
jcwang@fudan.edu.cn
older populations [14, 23]. Older adults with cognitive decline
* Judy Zhong have been shown more likely to develop mild cognitive im-
judy.zhong@nyulangone.org
pairment (MCI) and dementia, leading to a series of adverse
1
Ministry of Education Key Laboratory of Contemporary
outcomes such as disability and mortality [18, 25]. Depression
Anthropology, Collaborative Innovation Center for Genetics and and cognitive decline frequently occur concurrently, although
Development, School of Life Sciences, Fudan University, their relationship is still unclear [3]. Some studies have shown
Shanghai, China that depression is a prodromal symptom for rapid cognitive
2
Human Phenome Institute, Fudan University, Shanghai, China decline, while others have indicated that depression and cog-
3
State Key Laboratory of Genetic Engineering, School of Life nitive decline share some common risk factors [4, 9, 14].
Sciences, Fudan University, Shanghai, China Nevertheless, studies addressing the relationship between
4
Division of Biostatistics, School of Medicine, New York University, depression and cognitive decline have mostly been conducted
New York City, USA in prospective studies. Most studies only used baseline

depressive symptoms to detect subsequent cognitive changes [1,
14, 15, 26]. There is also a lack of studies that have examined
how changes in depressive symptoms affect cognitive decline.
Here, we propose the following hypothesis: both the baseline
depression level and the subsequent change in depressive symp-
toms affect cognitive decline in the older population.
In this study, we conducted analyses in a Chinese older
population cohort from the Rugao Longevity and Ageing
Study (RuLAS). To reduce the effect of those who already
had cognitive impairments, we conducted this study in a pop-
ulation with relatively normal cognitive function at baseline.
After summarizing the characteristics of the study population,
we grouped the participants based on their rate of depressive
symptom change over 3 years indicated by Geriatric
Depression Scale (GDS) scores and compared the trajectories
in cognition in these different groups. Moreover, we supple-
mented our analysis by another method of grouping. By
grouping participants based on the baseline GDS scores and
using a linear mixed model (LMM), we examined the rela-
tionship between baseline depressive symptoms and cognitive
decline in the Chinese population.
Methods
Population
The data were from the Rugao Longevity and Ageing Study
(RuLAS) [19, 22]. The study is a population-based observa-
tional two-arm cohort study conducted in Rugao, China.
Briefly, 1788 older people aged 70–84 years were recruited
at baseline, which was between November 13, 2014, and
December 21, 2014. Our first follow-up was conducted after
1.5 years in the summer of 2016, and the second follow-up
was conducted in the winter of 2017 (3 years after baseline). In
the present study, we defined our analysis sample by selecting
participants who completed the three examinations and ex-
cluding those who already had cognitive impairments (HDS-
R ≤ 21.5) [12], which resulted in a sample containing 580
participants. This study was approved by the Human Ethics
Committee of the School of Life Sciences of Fudan
University, Shanghai, China. Written consent was obtained
from all participants before participation.
Measures for depressive symptoms
Depressive symptoms in the older Chinese population were
measured by the Chinese version of the 15-item Geriatric
Depression Scale (GDS-15). The GDS is a depression assess-
ment scale specifically designed for older adults. Based on the
30-item long version, the short-form GDS that included 15
questions was developed in 1986 [21]. Among the 15 items,
negative answers to four questions indicated the presence of
Neurol Sci
depressive symptoms (item numbers 1, 5, 7, 11), while posi-
tive answers to the remaining items indicated the presence of
depressive symptoms. Previous studies have shown that the
GDS-15 achieved high validity and reliability and was appli-
cable in older populations [21]. In our study, we used a score
of 5 as the cutoff, which meant that scores of 0–4 implied a
normal, nondepressed status, and scores larger than 5 indicat-
ed depression.
Outcome of interest
We assessed cognitive function in older Chinese adults with
the Revised Hasegawa Dementia Scale (HDS-R). This scale
has been used to effectively assess different areas of cognitive
function including orientation, memory, attention/calculation,
and verbal fluency. The HDS-R has been widely used in ep-
idemiological surveys worldwide [13] and has been shown to
be reliable in assessing global cognitive function [24].
Demographic covariates
The following characteristics were included as covariates in
this study: age; gender (male, female); marital status (currently
married, other (never married, divorced, separated, or
widowed)); education (illiterate, literate (more than 1 year of
education)); smoking (nonsmoker, smoker, and former smok-
er); drinking (nondrinker, drinker, and former drinker); fasting
levels of plasma glucose; body mass index (BMI); perceived
health (good, bad), and hypertension (yes, no).
Perceived health was evaluated by asking the participants
the following question: “In general, compared with other peo-
ple of the same age, would you say that your health is excel-
lent, very good, good, fair, or poor.” We recoded the first three
levels (excellent, very good, and good) as “good” and the last
two levels (fair, poor) as “bad”. The participants were classi-
fied as having hypertension if their systolic and diastolic blood
pressure met the standard criteria for hypertension (SBP of ≥
140 mmHg, DBP of ≥ 90 mmHg) or if they had a history of
antihypertensive medication use. BMI was calculated as
weight in kilograms divided by height in meters squared.
The fasting plasma glucose test was performed after the par-
ticipants were fasted for at least 8 h to obtain a more precise
blood glucose level.
Statistical analysis
Our analysis started with descriptive statistics (means and
standard deviations for continuous measures and percentages
for categorical measures). For group comparisons, a two-
sample t test was used for continuous variables, while the
chi square test was used for categorical variables. To define
the magnitude of change in depressive symptoms in older
adults, we measured the rate of GDS change score using the
Neurol Sci

Table 1 Baseline characteristics

of the study population All Male Female p value

Gender 580 412 (71.03) 168 (28.97)

Age 74.83 ± 3.56 74.98 ± 3.65 74.47 ± 3.32 0.104
Marital status 0.004
Other 150 (26.04) 92 (22.55) 58 (34.52)
Married 426 (73.96) 316 (77.45) 110 (65.48)
Education 0.004
Illiterate 426 (73.96) 316 (77.45) 110 (65.48)
Literate 150 (26.04) 92 (22.55) 58 (34.52)
Smoking < 0.001
Nonsmoker 358 (61.83) 200 (48.54) 158 (94.61)
Smoker and former smoker 221 (38.17) 212 (51.46) 9 (5.39)
Drinking < 0.001
Nondrinker 347 (59.83) 208 (50.49) 139 (82.74)
Drinker and former drinker 233 (40.17) 204 (49.51) 29 (17.26)
Perceived health 0.078
Bad 104 (17.93) 66 (16.02) 38 (22.62)
Good 476 (82.07) 346 (83.98) 130 (77.38)
Hypertension 0.359
Yes 333 (57.41) 242 (58.74) 91 (54.17)
No 247 (42.59) 170 (41.26) 77 (45.83)
HDS-R 27.24 ± 3.18 27.96 ± 3.06 25.46 ± 2.75 < 0.001
GDS 1.86 ± 1.83 1.80 ± 1.85 2.02 ± 1.76 0.169
GLU 5.63 ± 1.82 5.50 ± 1.83 5.96 ± 1.75 0.005
BMI 24.24 ± 3.28 24.00 ± 3.03 24.84 ± 3.78 0.011

“average change per year” calculated with the following for-
mula:
Rate of GDS change
GDS score at endpoint−GDS score at baseline
¼ %:
time
We used a LMM to estimate the associations between cog-
nitive function and depression grouping for the repeated mea-
sures. We started with the unadjusted LMM model and con-
tinued to the multivariable LMM models by gradually adding
demographic covariates. In the unadjusted LMM model, the
dependent variable was the cognition indicated by HDS-R
scores, and the independent variable was the grouping based
on depression changes or baseline depression (GDS groups)
and time, and the interaction term between GDS groups and
time. A significant interaction term would indicate that the
slope of how the HDS-R scores change was significantly dif-
ferent between the GDS groups. In the multivariable adjusted
LMM models, we gradually included the demographic covar-
iates described in the section above. The model used random
intercept and random slope for time for each individual to
accommodate for the fact that each individual was assessed
multiple times. All statistical analyses were conducted using R
(version 3.5.1).

Table 2 HDS-R measurements by gender across 2 follow-ups

HDS-R All Men Women

Baseline, n 580 412 168

Mean (± SD) 27.24 ± 3.18 27.96 ± 3.06 25.46 ± 2.75
1st follow-up 575 408 167
Mean (± SD) 25.69 ± 5.47 27.13 ± 4.76 22.18 ± 5.53
2nd follow-up 577 409 168
Mean (± SD) 24.26 ± 5.72 25.70 ± 5.26 20.76 ± 5.26
Fig. 1 HDS-R score trajectory in groups based on the rate of GDS change
 Neurol Sci

Table 3 Results from the LMM Table 4 Summary for the GDS groups

GDS group GDS group×time Group code Number

β p β p Baseline GDS = 0 1 119 (20.5%)

Baseline GDS = 1–3 2 380 (65.5%)
Model 1 0.487 0.121 − 0.673 < 0.001
Baseline GDS ≥ 4 3 81 (14.0%)
Model 2 0.703 0.014 − 0.674 < 0.001
All 580
Model 3 0.658 0.021 − 0.681 < 0.001
Model 4 0.595 0.036 − 0.589 < 0.001

The reference group is the depression steady group in all four models.
Model 1 HDS-R ~ GDS group × time
Model 2: HDS-R ~ GDS group × time + age + gender
Model 3: HDS-R ~ GDS group × time + age + gender +education
Model 4: HDS-R ~ GDS group × time + age + gender + education +
marital status + drink + smoke + perceived health + hypertension + glu +
BMI
Results
Characteristics of the study population
The participants aged 70–85 years at baseline included 412
males and 168 females with relatively normal cognition func-
tion (Table 1). The mean age was 74.83 ± 3.56 years. For the
participants at baseline, the mean HDS-R score was 27.96 ±
3.06 in the males, which was significantly greater than the
mean HDS-R score in the females (25.46 ± 2.75), with a p
value < 0.001. The male participants had better GDS-15
scores than the female participants, but this difference was
not significant (p = 0.169), with mean GDS scores of 1.80 ±
1.85 and 2.02 ± 1.76, respectively. Table 2 shows the cogni-
tive decline across the 3 years, and we can see that the HDS-R
scores declined in both the men and the women. Regarding
the other demographic covariates, the male participants had a
significantly higher percentage of married individuals, illiter-
ate individuals, smokers or former smokers, and drinkers or
former drinkers than the female participants.

Association between depressive symptom changes

and cognitive decline

After calculating the rate of the GDS score change over

Fig. 2 a HDS-R score trajectory in groups based on GDS scores at
baseline (2 groups). b HDS-R score trajectory in groups based on GDS
scores at baseline (3 groups)
3 years, we divided the participants into two groups based
on the median of the average change per year (0). The first
group comprised those whose GDS change rate was less than
0 per year, indicating that their depressive symptoms remained
steady or improved over 3 years, and are hereafter referred to
as the “depression steady group” (Fig. 1). The second group
comprised the older adults whose depressive symptoms dete-
riorated over 3 years and are hereafter referred to as the “de-
pression deterioration group.” Those in the depression deteri-
oration group tended to have better cognitive function at base-
line and declined faster than those in the depression steady
group. As shown in Fig. 1, those in the depression deteriora-
tion group had worse cognition than those in the depression
steady group after 3 years, even though the depression deteri-
oration group had slightly better cognition at baseline.
We further examined the association between the GDS
groups, based on depression changes, and cognitive decline
with the LMM (Table 3). In the crude model, the interaction
term between time and GDS groups was significant (β = −
Neurol Sci

Table 5 Cognitive status by time

stratifying patients according to HDS-R Baseline GDS = 0 Baseline GDS = 1~3 Baseline GDS ≥ 4
baseline GDS
Baseline, n 119 380 81
Mean (± SD) 27.76 ± 0.29 27.27 ± 0.16 26.33 ± 0.36
1st follow-up 119 376 80
Mean(± SD) 26.61 ± 0.46 25.58 ± 0.28 24.85 ± 0.63
2nd follow-up 119 377 81
Mean (± SD) 24.77 ± 0.54 24.32 ± 0.28 23.21 ± 0.69

0.673, p < 0.001), which indicated a significant difference in
the slope for HDS-R scores over time between the two groups.
On average, the HDS-R scores decreased 0.67 points faster
per year for individuals in the depression deterioration group
than for those in the depression steady group (p < 0.001). The
result remained significant even after adjusting for the effects
of different covariates. This indicated that those with rapidly
deteriorating depressive symptoms had a faster cognitive de-
cline rate than those with more stable depressive symptoms.
Association between baseline depressive symptoms
and cognitive decline
To further investigate the relationship between depressive
symptoms and cognitive decline, we conducted analyses with
the grouping based on baseline depressive symptoms. The
HDS-R scores declined over the 3 follow-ups in the older
adults both with and without depressive symptoms (the cutoff
for depressive symptoms on the GDS was 5). As shown in
Fig. 2, those with depressive symptoms (GDS ≥ 5 at baseline)
tended to have worse cognition than those without depressive
symptoms (GDS < 5 at baseline). For a more detailed analysis,
we divided the non-MCI population into three groups based
on their GDS scores at baseline: GDS = 0, GDS = 1~3, and
GDS ≥ 4 (Table 4). Those with GDS scores greater than 4 had
the worst cognitive function of the three groups, while those
with GDS scores of 0 had the best cognition of the three
groups (Fig. 2b, Table 5).
Moreover, we used the linear mixed model to examine the
relationship between depression grouping at baseline and
HDS-R scores 3 years later. In the crude model, those with
the worst GDS scores at baseline had significantly lower
HDS-R scores than those with the best GDS performance at
baseline (p = 0.003, Table 6). The result was still significant
after adjusting for the effects of age and gender (p = 0.024),
while it was not significant after adjusting for the effect of
education. The interaction term of time and GDS groups
was not significant, indicating that the slope of HDS-R chang-
es over 3 years was not significantly different among the three
groups. This result indicated that older adults with depression
have worse cognitive function, while the depression status at
baseline did not affect the rate of cognitive decline in the
subsequent years.
Discussion
In our study, we examined the relationship between depressive
symptoms and cognitive decline in a sample from the Chinese
population in the Rugao Longevity and Ageing Study. We
found that the older population with depressive symptom de-
terioration had a faster decline in cognitive function than those
with steady depression status. The difference was mainly

Table 6 LMM results of baseline GDS group prediction

Time GDS group 2 GDS group 3 GDS group 2 × time GDS group 3 × time

β p β p β p β p β p

Model 1 − 0.996 < 0.001 − 0.681 0.07 − 1.522 0.003 0.008 0.967 − 0.045 0.857
Model 2 − 0.736 < 0.001 − 0.418 0.224 − 1.07 0.024 0.009 0.962 − 0.045 0.856
Model 3 − 0.736 < 0.001 − 0.410 0.232 − 0.889 0.061 − 0.001 0.996 − 0.067 0.788
Model 4 − 0.670 < 0.001 − 0.244 0.476 − 0.659 0.166 − 0.071 0.695 − 0.157 0.532

The reference group is the GDS = 0 group in all four models.

Model 1: HDS-R ~ GDS group × time
Model 2: HDS-R ~ GDS group × time + age + gender
Model 3: HDS-R ~ GDS group × time + age + gender + education
Model 4: HDS-R ~ GDS group × time + age + gender + education + marital status + drink + smoke + perceived health + hypertension + glu + BMI

reflected in the slope of the HDS-R change in the two groups.
Moreover, older adults with worse depressive symptoms had
worse cognitive function, while baseline depression status
was not associated with subsequent changes in cognition.
These results were still significant after including several po-
tential confounding factors in the linear mixed model, such as
age, gender, education, marital status, drinking and smoking
status, perceived health, hypertension status, the level of plas-
ma glucose, and BMI. These factors have been closely related
to depression and cognitive function [2, 6–8].
Among previous studies, Raji et al. and Downer et al. plot-
ted the trajectory of cognitive decline in depressed and non-
depressed groups only to support the notion that depressive
symptoms were associated with subsequent cognitive decline
without further investigation [8, 20]. However, we examined
both the changes in depressive symptoms (GDS scores) and
cognitive function (HDS-R scores) in our longitudinal study.
Similar to our study, Chen et al. explored changes in depres-
sion, indicated by Center for Epidemiologic Studies
Depression Scale (CES-D) scores, based on patterns of chang-
es in cognition [6]. In contrast to the conclusion in Chen’s
study, which found no time and group interaction with the
CES-D scores, our study found that those with a deterioration
in depressive symptoms also experienced faster cognitive de-
cline, and these differences were reflected in the trend of
HDS-R scores and shown by a significant interaction term
between time and GDS groups. This difference may be be-
cause Chen et al. used the scales CES-D and SPMSQ scales as
indicators of depressive symptoms and cognition, respective-
ly, instead of the GDS-15 and HDS-R scales used in our study.
In the present study, we balanced the number of participants in
each GDS group by adopting the GDS grouping in Table 4. We
found that the association was still significant after adjusting for
the effects of age and gender. However, the result was not sig-
nificant after adjusting for the effect of education. The study by
Geerlings et al. in the Netherlands implied that the relationship
between depression and incident Alzheimer’s disease was only
significant in a high education population [11]. This may explain
the nonsignificant results with our model since more than 74% of
our participants were illiterate.
Previous studies have explored the relationships between de-
pressive symptoms at baseline and cognitive decline in different
populations, such as Mexican-Americans, Netherlanders and
Taiwan Chinese populations. In older Mexican-Americans,
Downer et al. found that depression was significantly associated
with greater cognitive decline [8]. Similarly, Köhler et al. showed
that the odds ratio for developing cognitive impairment was sig-
nificant for the highest vs. lowest depression quartile at baseline
in a population cohort in the Netherlands [17]. In a study con-
ducted in Taiwan, Chang et al. showed that men with long-term
depressive symptoms had a greater risk of cognitive decline than
those without long-term depressive symptoms [5]. We found
similar results in our mainland Chinese non-MCI participants.
Neurol Sci
Moreover, previous studies used the MMSE to characterize
cognitive function [8, 26]. Regarding the scales used to esti-
mate depressive symptoms, some studies have used the CES-
D, while others have used the GDS-30 or GDS-15 [5, 15, 26].
Supported by the research by Fried et al. in 2017, these differ-
ent instruments may have evaluated different aspects of de-
pressive symptoms with little overlap [10, 14]. Our study used
a combination of the HDS-R and GDS-15 scales, and the
results were in accordance with the abovementioned studies
using different scales to assess cognition or depression. The
present results generalized the previously found relationship
between depressive symptoms and cognitive decline to a
Chinese population.
One disadvantage of our study was the relatively short
follow-up period (i.e., 3 years) since it may take a longer
period of time for cognitive or depressive symptoms to prog-
ress. Moreover, since only 81 participants had GDS scores
greater than 4 at baseline after excluding MCI participants,
the effect size was relatively small to assess the relationship
between depression and cognitive decline compared with
some cohort studies with many more participants [11, 16].
Conclusions
In summary, deterioration of depressive symptoms was signif-
icantly associated with faster cognitive decline in the Chinese
population involved in the Rugao Longevity and Ageing
Study. The result was still significant after adjusting for de-
mographic covariates. While those with worse depressive
symptoms at baseline tended to have worse cognitive func-
tion, it was the rate in depressive symptoms change that influ-
enced the rate in cognitive decline. Apparently, more analyses
are required in our cohort study to further explore the relation-
ship between depression and cognitive impairment with a lon-
ger follow-up period. This study is of great importance to the
treatment of cognitive decline in older populations since inter-
ventions targeting associated depressive symptoms may im-
prove the cognitive impairment observed in older people later
in their lives.
Acknowledgments We acknowledge all participants involved in the
study.
Funding information This work was financially supported by grants
from the National Key R&D Program of China (2018YFC2000400),
the National Natural Science Foundation of China (31521003), and
Shanghai Municipal Science and Technology Major Project
(2017SHZDZX01).
Compliance with ethical standards
Conflict of interest The authors declare that they have no conflict of
interest.
Neurol Sci
Ethical approval The Human Ethics Committee of the School of Life
Sciences of Fudan University, Shanghai, China, approved this study.
Written consent was obtained from all participants prior to the study.
References
1. Bassuk SS, Berkman LF, Wypij D (1998) Depressive symptomatol-
ogy and incident cognitive decline in an elderly community sample.
Arch Gen Psychiatry 55:1073–1081
2. Baumgart M, Snyder HM, Carrillo MC et al (2015) Summary of the
evidence on modifiable risk factors for cognitive decline and de-
mentia: a population-based perspective. Alzheimers Dement 11(6):
718–726
3. Bennett S, Thomas AJ (2014) Depression and dementia: cause,
consequence or coincidence? Maturitas 79:184–190
4. Brommelhoff JA, Gatz M, Johansson B, McArdle JJ, Fratiglioni L,
Pedersen NL (2009) Depression as a risk factor or prodromal fea-
ture for dementia? Findings in a population-based sample of
Swedish twins. Psychol Aging 24:373
5. Chang SL, Tsai AC (2015) Gender differences in the longitudinal
associations of depressive symptoms and leisure-time physical ac-
tivity with cognitive decline in ≥ 57 year-old Taiwanese. Prev Med
77:68–73
6. Chen T-Y, Chang H-Y (2016) Developmental patterns of cognitive
function and associated factors among the elderly in Taiwan. Sci
Rep 6:33486
7. Cole MG, Dendukuri N (2003) Risk factors for depression among
elderly community subjects: a systematic review and meta-analysis.
Am J Psychiatr 160(6):1147–1156
8. Downer B, Vickers BN, Al Snih S, Raji M, Markides KS (2016)
Effects of comorbid depression and diabetes mellitus on cognitive
decline in older Mexican Americans. J Am Geriatr Soc 64:109–117
9. Enache D, Winblad B, Aarsland D (2011) Depression in dementia:
epidemiology, mechanisms, and treatment. Curr Opin Psychiatry
24:461–472
10. Fried EI (2017) The 52 symptoms of major depression: lack of
content overlap among seven common depression scales. J Affect
Disord 208:191–197
11. Geerlings MI et al (2000) Depression and risk of cognitive decline
and Alzheimer’s disease: results of two prospective community-
based studies in The Netherlands. Br J Psychiatry 176:568–575
12. Haiying L (2001) Studying on relationship between Hasegawa de-
mentia scale and nursing care of senile dementia patients.
Heilongjiang Nursing J 7
13. Imai Y, Hasegawa K (1994) The revised Hasegawa’s dementia
scale (HDS-R)-evaluation of its usefulness as a screening test for
dementia. Hong Kong J Psychiatry 4:20
14. John A, Patel U, Rusted J, Richards M, Gaysina D (2019) Affective
problems and decline in cognitive state in older adults: a systematic
review and meta-analysis. Psychol Med 49:353–365
15. Johnson LA, Hall JR, O’Bryant SE (2013) A depressive
endophenotype of mild cognitive impairment and Alzheimer’s dis-
ease. PLoS One 8:e68848
16. Katon W, Pedersen HS, Ribe AR, Fenger-Grøn M, Davydow D,
Waldorff FB, Vestergaard M (2015) Effect of depression and dia-
betes mellitus on the risk for dementia: a national population-based
cohort study. JAMA Psychiatry 72:612–619
17. Köhler S, van Boxtel M, van Os J, Thomas AJ, O'Brien JT, Jolles J,
Verhey FR, Allardyce J (2010) Depressive symptoms and cognitive
decline in community-dwelling older adults. J Am Geriatr Soc 58:
873–879
18. Larrieu S et al (2002) Incidence and outcome of mild cognitive
impairment in a population-based prospective cohort. Neurology
59:1594–1599
19. Liu Z et al (2015) Cohort profile: the Rugao longevity and ageing
study (RuLAS). Int J Epidemiol 45:1064–1073
20. Raji MA, Reyes-Ortiz CA, Kuo Y-F, Markides KS, Ottenbacher KJ
(2007) Depressive symptoms and cognitive change in older
Mexican Americans. J Geriatr Psychiatry Neurol 20:145–152
21. Sheikh JI, Yesavage JA (1986) Geriatric depression scale (GDS):
recent evidence and development of a shorter version Clin
Gerontol: The Journal of Aging and Mental Health
22. Shi G-P, Ma T, Zhu YS, Wang ZD, Chu XF, Wang Y, Chen ZK, Xu
WD, Wang XF, Guo JH, Jiang XY (2019) Frailty phenotype, frailty
index and risk of mortality in Chinese elderly population-Rugao
longevity and ageing study. Arch Gerontol Geriatr 80:115–119
23. Tabbarah M, Crimmins EM, Seeman TE (2002) The relationship
between cognitive and physical performance: MacArthur Studies of
Successful Aging. J Gerontol Ser A Biol Med Sci 57:M228–M235
24. Tsukamoto R, Akisaki T, Kuranaga M, Takata T, Yokono K,
Sakurai T (2009) Hasegawa dementia scale–revised, for screening
of early Alzheimer's disease in the elderly with type 2 diabetes.
Geriatr Gerontol Int 9:213–215
25. Wilson RS, Schneider JA, Boyle PA, Arnold SE, Tang Y, Bennett
DA (2007) Chronic distress and incidence of mild cognitive impair-
ment. Neurology 68:2085–2092
26. Yaffe K, Blackwell T, Gore R, Sands L, Reus V, Browner WS
(1999) Depressive symptoms and cognitive decline in
nondemented elderly women: a prospective study. Arch Gen
Psychiatry 56:425–430
Publisher’s note Springer Nature remains neutral with regard to jurisdic-
tional claims in published maps and institutional affiliations.