抑郁症状与痴呆之间的时间关系：一项基于社区的前瞻性研究。

The temporal relationship between depressive symptoms and dementia: a community-based prospective study.

作者信息

Chen P, Ganguli M, Mulsant B H, DeKosky S T

机构信息

Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA, USA.

出版信息

Arch Gen Psychiatry. 1999 Mar;56(3):261-6. doi: 10.1001/archpsyc.56.3.261.

DOI:10.1001/archpsyc.56.3.261

PMID:10078504

Abstract

BACKGROUND

The temporal relationship between the appearance of depressive symptoms and the clinical onset of dementia and Alzheimer disease was evaluated in a community sample.

METHODS

An original sample of 1366 subjects aged 65 years or older, selected randomly from a rural Pennsylvania community, was cognitively screened at study entry and every 2 years thereafter. A subset of 954 survivors of this cohort without dementia was screened for depressive symptoms at the second and subsequent data-collection waves. A "depression cluster" was identified by the presence of 5 or more depressive symptoms, including depressed mood, at the time of screening. Cognitively impaired subjects and a sample of unimpaired controls underwent standardized clinical evaluation to determine the presence of incident dementia (by DSM-III-R criteria) and probable or possible Alzheimer disease (by criteria of the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association) and to estimate the clinical onset of dementia symptoms.

RESULTS

A highly increased probability of the depression cluster developing existed among subjects following the onset of dementia (15.4% [6/39]) and Alzheimer disease (17.6% [6/34]) compared with subjects without dementia (3.2% [23/712]). The odds ratios, after adjustment for age, sex, education level, and self reported memory loss, for the development of depression were 6.5 (95% confidence interval, 2.2-19.1) in subjects with Alzheimer disease and 5.2 (95% confidence interval, 1.8-15.2) in subjects with overall dementia. Depressive symptoms did not confer a significantly increased relative risk of dementia (1.27; 95% confidence interval, 0.55-2.93) or Alzheimer disease (1.28; 95% confidence interval, 0.51-3.20).

CONCLUSION

Depressive symptoms appeared to be early manifestations, rather than predictors, of Alzheimer disease in this community sample.

摘要

背景

在一个社区样本中评估了抑郁症状出现与痴呆症和阿尔茨海默病临床发病之间的时间关系。

方法

从宾夕法尼亚州一个农村社区随机选取1366名65岁及以上的受试者作为原始样本，在研究开始时以及此后每2年进行一次认知筛查。该队列中954名无痴呆症的幸存者在第二次及后续数据收集波次中接受了抑郁症状筛查。通过在筛查时出现5种或更多抑郁症状（包括情绪低落）来确定“抑郁簇”。认知受损的受试者和未受损的对照样本接受标准化临床评估，以确定是否存在新发痴呆症（根据DSM-III-R标准）以及可能或疑似阿尔茨海默病（根据美国国立神经疾病和中风研究所以及阿尔茨海默病及相关疾病协会的标准），并估计痴呆症状的临床发病情况。

结果

与无痴呆症的受试者（3.2%[23/712]）相比，痴呆症（15.4%[6/39]）和阿尔茨海默病（17.6%[6/34]）发病后的受试者中出现“抑郁簇”的概率大幅增加。在调整年龄、性别、教育水平和自我报告的记忆丧失后，阿尔茨海默病患者出现抑郁的比值比为6.5（95%置信区间，2.2 - 19.1），总体痴呆症患者为5.2（95%置信区间，1.8 - 15.2）。抑郁症状并未使痴呆症（1.27；95%置信区间，0.55 - 2.93）或阿尔茨海默病（1.28；95%置信区间，0.51 - 3.20）的相对风险显著增加。