Yaffe K, Blackwell T, Gore R, Sands L, Reus V, Browner W S
Department of Psychiatry, University of California-San Francisco School of Medicine, and the Veterans Affairs Medical Center, 94121, USA.
Arch Gen Psychiatry. 1999 May;56(5):425-30. doi: 10.1001/archpsyc.56.5.425.
The association between depressive disorders and subsequent cognitive decline is controversial. We tested the hypothesis that elderly women (aged 65 years and older) without dementia but with depressive symptoms have worse cognitive function and greater cognitive decline than women with few or no symptoms.
As part of an ongoing prospective study, we evaluated 5781 elderly, mostly white, community-dwelling women. Women completed the Geriatric Depression Scale short form. Three cognitive tests--Trails B, Digit Symbol, and a modified Mini-Mental State Examination--were administered at baseline and approximately 4 years later. Baseline, follow-up, and change scores for the cognitive tests were analyzed by analysis of covariance and Kruskal-Wallis analysis; the odds of cognitive deterioration (> or =3-point decline on the modified Mini-Mental State Examination) were determined by logistic regression.
At baseline, 211 (3.6%) of the women had 6 or more depressive symptoms. Only 16 (7.6%) of these women were receiving antidepressant medication. Increasing symptoms of depression were associated with worse performance at baseline and follow-up on all 3 tests of cognitive function (P<.001 for all comparisons). For example, the baseline Digit Symbol score (mean +/- SD) was 45.5 +/- 10.7 among women with 0 to 2 symptoms of depression, 40.3 +/- 10.7 for women with 3 to 5 symptoms, and 39.0 +/- 11.3 for women with 6 or more symptoms. After adjusting for the baseline score, cognitive change scores were also inversely associated with the number of depressive symptoms (P<.001 for all comparisons). Odds ratios for cognitive deterioration using 0 to 2 symptoms as the reference were 1.6 (95% confidence interval, 1.3-2.1) for 3 to 5 symptoms and 2.3 (95% confidence interval, 1.6-3.3) for 6 or more symptoms. Results were similar after being adjusted for education, age, health status, exercise, alcohol use, functional status, and clinic site.
Depressive symptoms in older women are associated with both poor cognitive function and subsequent cognitive decline. Mechanisms underlying the association between these 2 common conditions need further exploration.
抑郁症与随后的认知功能衰退之间的关联存在争议。我们检验了这样一个假设：无痴呆但有抑郁症状的老年女性（65岁及以上）比症状较少或无症状的女性认知功能更差且认知衰退更严重。
作为一项正在进行的前瞻性研究的一部分，我们评估了5781名大多为白人、居住在社区的老年女性。女性完成了简易老年抑郁量表。在基线时以及大约4年后进行了三项认知测试——连线测验B、数字符号测验和改良简易精神状态检查表。通过协方差分析和克鲁斯卡尔 - 沃利斯分析对认知测试的基线、随访和变化分数进行分析；通过逻辑回归确定认知功能恶化（改良简易精神状态检查表下降≥3分）的几率。
在基线时，211名（3.6%）女性有6个或更多抑郁症状。这些女性中只有16名（7.6%）正在接受抗抑郁药物治疗。抑郁症状增加与所有三项认知功能测试在基线和随访时的较差表现相关（所有比较P<0.001）。例如，抑郁症状为0至2个的女性基线数字符号得分（均值±标准差）为45.5±10.7，3至5个症状的女性为40.3±10.7，6个或更多症状的女性为39.0±11.3。在对基线分数进行调整后，认知变化分数也与抑郁症状数量呈负相关（所有比较P<0.001）。以0至2个症状为参照，3至5个症状组认知功能恶化的优势比为1.6（95%置信区间，1.3 - 2.1），6个或更多症状组为2.3（95%置信区间，1.6 - 3.3）。在对教育程度、年龄、健康状况、运动、饮酒、功能状态和诊所地点进行调整后，结果相似。
老年女性的抑郁症状与较差的认知功能以及随后的认知衰退均相关。这两种常见情况之间关联的潜在机制需要进一步探索。
