Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, USA.
J Gen Intern Med. 2010 May;25(5):423-9. doi: 10.1007/s11606-009-1248-6. Epub 2010 Jan 28.
Both depression and diabetes have been found to be risk factors for dementia. This study examined whether comorbid depression in patients with diabetes increases the risk for dementia compared to those with diabetes alone.
We conducted a prospective cohort study of 3,837 primary care patients with diabetes (mean age 63.2 +/- 13.2 years) enrolled in an HMO in Washington State. The Patient Health Questionnaire (PHQ-9) was used to assess depression at baseline, and ICD-9 diagnoses for dementia were used to identify cases of dementia. Cohort members with no previous ICD-9 diagnosis of dementia prior to baseline were followed for a 5-year period. The risk of dementia for patients with both major depression and diabetes at baseline relative to patients with diabetes alone was estimated using cause-specific Cox proportional hazard regression models that adjusted for age, gender, education, race/ethnicity, diabetes duration, treatment with insulin, diabetes complications, nondiabetes-related medical comorbidity, hypertension, BMI, physical inactivity, smoking, HbA(1c), and number of primary care visits per month.
Over the 5-year period, 36 of 455 (7.9%) patients with major depression and diabetes (incidence rate of 21.5 per 1,000 person-years) versus 163 of 3,382 (4.8%) patients with diabetes alone (incidence rate of 11.8 per 1,000 person-years) had one or more ICD-9 diagnoses of dementia. Patients with comorbid major depression had an increased risk of dementia (fully adjusted hazard ratio 2.69, 95% CI 1.77, 4.07).
Patients with major depression and diabetes had an increased risk of development of dementia compared to those with diabetes alone. These data add to recent findings showing that depression was associated with an increased risk of macrovascular and microvascular complications in patients with diabetes.
抑郁和糖尿病均被发现是痴呆的危险因素。本研究旨在探讨与单纯糖尿病患者相比，合并抑郁的糖尿病患者发生痴呆的风险是否更高。
我们对华盛顿州 HMO 中 3837 名患有糖尿病的初级保健患者（平均年龄 63.2±13.2 岁）进行了前瞻性队列研究。使用患者健康问卷（PHQ-9）在基线时评估抑郁情况，并使用 ICD-9 诊断痴呆来确定痴呆病例。在基线前无 ICD-9 痴呆诊断的队列成员随访 5 年。使用基于病因的 Cox 比例风险回归模型，调整年龄、性别、教育程度、种族/民族、糖尿病病程、胰岛素治疗、糖尿病并发症、非糖尿病相关合并症、高血压、BMI、身体活动量、吸烟、HbA1c 和每月就诊次数后，评估基线时合并重度抑郁症和糖尿病的患者与单纯糖尿病患者相比发生痴呆的风险。
在 5 年期间，455 名合并重度抑郁症和糖尿病的患者中有 36 名（发生率为 21.5/1000 人年），3382 名单纯糖尿病患者中有 163 名（发生率为 11.8/1000 人年）发生了一次或多次 ICD-9 诊断的痴呆。合并重度抑郁症的患者痴呆风险增加（完全调整后的危险比 2.69，95%CI 1.77，4.07）。
与单纯糖尿病患者相比，合并重度抑郁症和糖尿病的患者发生痴呆的风险增加。这些数据增加了最近的发现，即抑郁与糖尿病患者大血管和微血管并发症的风险增加有关。
