Association of epilepsy with trajectory of depressive symptoms in late life: The Cardiovascular Health Study

Abstract Objectives Although depression is one of the most common psychiatric comorbidities among individuals with epilepsy, data specific to older adults with epilepsy are scarce. We examined the trajectory of depressive symptom scores in older adults with and without epilepsy. Methods The Cardiovascular Health Study is a population‐based longitudinal cohort of U.S. adults 65 years of age or older. Depression scores were measured annually using the 10‐item Center for Epidemiologic Studies Depression Scale (CESD‐10) for up to 9 years of follow‐up. We used a linear mixed model to estimate mean CESD‐10 scores and percent with depression (CESD‐10 score ≥10) over time by epilepsy status, adjusted for demographics, health behaviors, clinical characteristics, and measures of life satisfaction. Results CESD‐10 scores increased at a significantly faster rate over 9 years among older adults with epilepsy ( n = 190; 2.8 points) compared to those without epilepsy ( n = 5264; 1.8 points; p = 0.005), adjusted for the covariates specified above. The proportion of those who met the threshold for depression also increased at a significantly faster rate among older adults with epilepsy compared to those without epilepsy. The proportion with depression increased by 19.8 cases per 100 (95% confidence interval [CI]: 12.9–26.6) in older adults with epilepsy, compared to an increase of 10.2 cases per 100 (95% CI: 9.0–11.4) in those without epilepsy (a difference in the increase of 9.6 additional cases per 100 [95% CI: 2.7–16.5]; p = 0.007), adjusted for covariates. The association of epilepsy with CESD‐10 score trajectory did not differ by sex. Significance Older adults with epilepsy experience worse depressive symptom trajectories over time compared to older adults without epilepsy, with one in five individuals experiencing depression over 9 years. These findings highlight the need for systematic and repeated screening of depression in older adults with epilepsy.