Depression, vascular burden, and dementia prevalence in late middle-aged and older Black adults.

Late-life depression and white matter hyperintensities (WMHs) have been linked to increased dementia risk. However, there is a dearth of literature examining these relationships in Black adults. We investigated whether depression or WMH volume are associated with a higher likelihood of dementia diagnosis in a sample of late middle-aged to older Black adults, and whether dementia prevalence is highest in individuals with both depression and higher WMH volume. Secondary data analysis involved 443 Black participants aged 55+ with brain imaging within one year of baseline visit in the National Alzheimer's Coordinating Center (NACC) Uniform Data Set. Chi-square analyses and logistic regression models controlling for demographic variables examined whether active depression in the past two years, WMH volume, or their combination were associated with higher odds of all-cause dementia. Depression and higher WMH volume were associated with a higher prevalence of dementia. These associations remained after controlling for demographic factors, as well as vascular disease burden. Dementia risk was highest in the depression/high WMH volume group compared to the depression only group, high WMH volume only group, and the no depression/low WMH volume group. Post-hoc analyses comparing the Black sample to a demographically matched non-Hispanic White sample showed associations of depression and the combination of depression and higher WMH burden with dementia were greater in Black compared to non-Hispanic White individuals. Results suggest late-life depression and WMHs have independent and joint relationships with dementia and that Black individuals may be particularly at risk due to these factors.

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