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doi:10.1111/j.1440-1819.2012.02347.x
Short Communication
367..369
Hsi-Han Chen,
LDERLY PERSONS COMMONLY have hemoglobin (Hb) concentrations slightly below the lower
normal limit. A previous study reported that anemia
is associated with changes in quality of life, increased
risk of falls, infections, morbidity, and mortality in
the elderly.1 However, few studies have investigated
the influence of anemia on mental function in these
individuals. The association between anemia and
depression or cognitive function in the elderly
remains controversial. A Japanese analysis indicated
that lower Hb levels were significantly associated
with depressive moods in elderly women at high risk
of requiring care, though not in elderly men.2 A prospective population-based study in Italy showed that
depressive symptoms were associated with anemia in
a general population of older persons living in the
community,3 while a cross-sectional study found that
mild-grade anemia was independently associated
with worse selective attention.4 Another sectional
study in Turkey observed greater impairment to
METHODS
This study comprised 180 participants recruited from
a veterans home in Northern Taiwan. For each case,
the clinical research assistant performed an extensive
examination, including a diagnostic structured interview with the Mini-International Neuropsychiatric
Interview (MINI),6 the Geriatric Depression Scale
(GDS-15), the Clinical Dementia Rating Scale (CDR),
and cognitive tests, including the Cognitive Abilities
Screening Instrument Chinese version (CASI C-2.0)
test,7 and the Wechsler Digit Span Task test (Forward
and Backward). The CASI test is a 100-point cognitive
367
12
10
GDS-15
0
7.5
10.0
12.5
15.0
17.5
Hemoglobin (g/dl)
RESULTS
The subjects were 180 men aged between 65 and
98 years (mean = 85.8; SD = 10.5), with an average
of 5.1 years of education (SD = 4.6; ranged from 0 to
16 years of schooling). Cognitive function tests
showed that the mean total CASI score was 85.3
6.6 (range = 6898). Hb concentrations ranged from
6.1 to 17.3 g/dL, with an average of 13.5 g/dL (SD =
1.8 g/dL). Mean scores for GDS-15, Digit Span
Forward test, Digit Span Backward test and CDR were
2.9 (SD = 2.7), 11.4 (SD = 3.0), 3.4 (SD = 2.1) and
0.1 (SD = 0.2), respectively.
Pearsons correlation tests demonstrated that Hb
concentrations negatively correlated with GDS-15
(r = -0.245, P = 0.001) (Fig. 1). Among the 180 subjects, 56 were current smokers. After controlling for
age, education years and smoking status, the correlation was still significant (r = -0.261, P < 0.001). Hb
concentrations did not correlate with cognitive tests,
including CASI (P = 0.879), Forward Digit Span
(P = 0.286) and Backward Digit Span (P = 0.172).
After controlling for age, education years and
smoking status, the correlation was still insignificant
(data not shown). A linear-regression analysis performed with age, education years, and Hb concentrations as the predictor variables identified education
years as the only significant predictor of CASI score
(P < 0.001).
DISCUSSION
The results of this study indicate that Hb concentrations negatively correlated with depression, as evaluated using GDS-15, and did not correlate with
cognitive function. Our findings are consistent with
those of a previous study on English communitydwelling older adults (3816 men and women; aged
65.4 9.0 years),9 but differed from those from a
Japanese analysis that showed no significant association between Hb levels and depressed mood in
elderly men at a high risk of requiring care.2 This
discrepancy may be caused by sample differences,
ethnic differences, or different depression ratings. The
underlining mechanism of the link between lower
Hb levels and depressive mood still requires full elucidation. Anemia could worsen symptoms of fatigue,
irritability, and poor concentration, which are significant components of depression. Furthermore,
anemia reduces brain oxygenation,10 which may
affect brain function for stress coping. In a large longitudinal prospective study of English communitydwelling older adults, anemia did not predict risk of
depression over 2 years of follow up.9 Therefore, the
causal correlation may be in the reverse direction
(depression causes anemia). For example, lower Hb
may be a consequence of poor dietary iron intake
among subjects with more depressed moods.
ACKNOWLEDGMENTS
There are no conflicts of interest to disclose.
REFERENCES
1. Woodman R, Ferrucci L, Guralnik J. Anemia in older
adults. Curr. Opin. Hematol. 2005; 12: 123128.
2. Umegaki H, Yanagawa M, Endo H. Association of lower
hemoglobin level with depressive mood in elderly women
at high risk of requiring care. Geriatr. Gerontol. Int. 2011;
11: 262266.