A loss of confidence in midlife could be an early warning that it is worth taking steps to protect your long-term brain health, a study suggests.
Research found that middle-aged people with certain symptoms, including losing confidence or feeling overwhelmed when problems arose, had a significantly higher risk of developing dementia decades later.
“Paying attention to these patterns could open new opportunities for early prevention,” said Dr Philipp Frank, the lead author of the study, from the psychiatry division at University College London (UCL).
There is no guaranteed way to prevent dementia, but researchers say there is growing evidence that lifestyle during middle age plays a role. Staying physically active, mentally engaged and maintaining social connections are all thought to help build “cognitive reserve”, the brain’s ability to cope with age-related changes and disease.
Studies suggest treating depression may lower dementia risk and improve symptoms
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The study, published in The Lancet Psychiatry, identified six specific symptoms linked to depression that were associated with an increased risk of dementia later in life. They included “losing confidence in myself”, “not able to face up to problems”, “not feeling warmth and affection for others”, “feeling nervous and strung-up all the time”, “not being satisfied with the way tasks are carried out” and “difficulties concentrating”.
The researchers analysed data from the Whitehall II study, which tracked nearly 6,000 British civil servants. Participants were recruited at an average age of 56; about 90 per cent were white and 70 per cent were men. They were followed for an average of 23 years, during which time roughly 10 per cent developed dementia.
The researchers stressed that not everyone who had depression would develop dementia
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Loss of self-confidence and difficulty coping with problems in midlife were each linked with a roughly 50 per cent increased risk of dementia. Not feeling warmth and affection for others was associated with a 44 per cent increase. The remaining symptoms were each linked to a rise in risk of between 24 and 29 per cent.
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“Our findings show that dementia risk is linked to a handful of depressive symptoms rather than depression as a whole,” Frank said. “This symptom-level approach gives us a much clearer picture of who may be more vulnerable decades before dementia develops.”
Professor Mika Kivimaki, who leads the Whitehall II study and is based at UCL’s faculty of brain sciences, said the results highlighted the complexity of depression. “Depression doesn’t have a single shape; symptoms vary widely and often overlap with anxiety,” he said. “We found that these nuanced patterns can reveal who is at higher risk.”
The findings come as dementia continues to place a growing burden on society. About 982,000 people in the UK are estimated to be living with dementia, according to the Alzheimer’s Society. The number is expected to rise sharply as the population ages.
The relationship between depression and dementia risk is complex because depression can be an early symptom of dementia
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Professor Gill Livingston, chair of the Lancet Commission on dementia prevention, intervention and care, said the study offered a fresh way of thinking about mental health in midlife. “This is a new and important way of considering depression and dementia, and it is more evidence that depression is a wide umbrella and not necessarily one illness,” she said. “There is some limited evidence that treating dementia in midlife might reduce later dementia risk, but further research is needed.”
She added: “There are many things you can do [which evidence suggests] reduces your chance of developing dementia. Some may be quite surprising, including hearing aids for impaired hearing.”
Kivimaki said: “There are a few important things everyone can do in midlife to help lower their dementia risk. These include avoiding smoking and heavy drinking, and keeping an eye on your weight, blood pressure, cholesterol and blood glucose. If any of these are too high, lifestyle changes or starting medication can make a real difference. For example, in people with high blood pressure, antihypertensive medication has been shown in randomised trials to help delay dementia.”
Experts also urged caution in interpreting the findings. Dr Richard Oakley, associate director of research and innovation at the Alzheimer’s Society, said: “It’s important to note that not everyone who has depression will go on to develop dementia, and people with dementia won’t necessarily develop depression.”