Rovner Barry W, Casten Robin J, Leiby Benjamin E
Department of Psychiatry and Neurology, Jefferson Medical College, Philadelphia, PA 19107, USA.
Am J Geriatr Psychiatry. 2009 Jul;17(7):574-81. doi: 10.1097/jgp.0b013e31819a7f46.
The measurement of affective symptoms in older persons who decline cognitively is uncertain. The authors investigated whether mood variability predicts dementia in patients with age-related macular degeneration (AMD).
Three-year observational study after a clinical trial.
Community follow-up of outpatients ascertained from retina clinics.
One hundred sixty patients with AMD.
Geriatric Depression Scale (GDS) administered every 2 weeks for 6 months to subjects; Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) administered to subjects' knowledgeable informants.
Twenty-three subjects (14.4%) declined cognitively. Age, education, baseline GDS score > or =5, and variability in GDS scores (i.e., fluctuations between adjacent time points) were associated with cognitive decline. For GDS variability, each 1 unit increase in the residual standard deviation (SD) of the GDS increased the risk for cognitive decline by 93% (IDR = 1.92; 95% CI [1.27-2.91]). Thus, subjects with a residual SD of 1 were nearly twice as likely to become demented as subjects with no variability in GDS scores. The risk for subjects with SDs of 2 increased more than threefold (IDR = 3.68; 95% CI [1.61-8.47]). A multiple regression analysis showed that GDS variability was a significant risk factor for dementia after controlling for significant covariates.
These data suggest a useful approach to conceptualizing and measuring depressive symptoms in older persons. Variability in self-reported mood may be an early sign of dementia and may offer new insights into the neurobiological mechanisms linking depression and cognition
认知功能下降的老年人情感症状的测量尚无定论。作者调查了情绪变异性是否可预测年龄相关性黄斑变性（AMD）患者的痴呆症。
一项临床试验后的三年观察性研究。
从视网膜诊所确定的门诊患者的社区随访。
160例AMD患者。
每2周对受试者进行一次老年抑郁量表（GDS）评估，共6个月；向受试者的知情者发放老年人认知功能下降知情者问卷（IQCODE）。
23名受试者（14.4%）出现认知功能下降。年龄、教育程度、基线GDS评分≥5以及GDS评分的变异性（即相邻时间点之间的波动）与认知功能下降相关。对于GDS变异性，GDS残差标准差（SD）每增加1个单位，认知功能下降的风险增加93%（发病率比值比[IDR]=1.92；95%可信区间[1.27 - 2.91]）。因此，残差SD为1的受试者患痴呆症的可能性几乎是GDS评分无变异性受试者的两倍。SD为2的受试者的风险增加了三倍多（IDR = 3.68；95%可信区间[1.61 - 8.47]）。多元回归分析表明，在控制了显著的协变量后，GDS变异性是痴呆症的一个显著风险因素。
这些数据提示了一种用于概念化和测量老年人抑郁症状的有用方法。自我报告情绪的变异性可能是痴呆症的早期迹象，并可能为连接抑郁和认知的神经生物学机制提供新的见解。
