Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, European Graduate School of Neuroscience, Maastricht University, Maastricht, the Netherlands.
J Am Geriatr Soc. 2010 May;58(5):873-9. doi: 10.1111/j.1532-5415.2010.02807.x. Epub 2010 Mar 30.
To examine the temporal association between depressive symptoms and cognitive functioning and estimate the effect measure modification of the apolipoprotein E (APOE) epsilon4 allele on this relationship.
Prospective cohort study.
General community.
Population-based sample of 598 cognitively intact older adults aged 60 and older, with re-assessments after 3 (N=479) and 6 years (N=412).
Depressive symptoms (Symptom Checklist) and neurocognitive functioning (memory, Visual Verbal Learning Test; attention, Stroop Color-Word Test; processing speed, Letter Digit Substitution Test; general cognition, Mini-Mental State Examination). Longitudinal associations were assessed using linear mixed models. The risk for cognitive impairment, no dementia (CIND) was examined using logistic regression.
Adjusting for age, sex, education, and baseline cognition, the rate of change in memory z-scores was 0.00, -0.11, -0.20, and -0.37 for those in the lowest (reference group), second, third, and highest depressive symptom quartiles at baseline, respectively (P<.001 for highest vs lowest quartile). The odds ratios for developing CIND with amnestic features were 1.00, 0.87, 0.69, and 2.98 for the four severity groups (P=.05 for highest vs lowest quartile). Associations were strongest for those with persistent depressive symptoms, defined as high depressive symptoms at baseline and at least one follow-up visit. Results were similar for processing speed and global cognitive function but were not as strong for attention. No APOE interaction was observed.
Depression and APOE act independently to increase the risk for cognitive decline and may provide targets for prevention and early treatment.
探讨抑郁症状与认知功能之间的时间关联，并估计载脂蛋白 E（APOE）ε4 等位基因对这种关系的效度量修正作用。
前瞻性队列研究。
一般社区。
基于人群的认知完整的 598 名 60 岁及以上老年人样本，在 3 年（N=479）和 6 年后重新评估（N=412）。
抑郁症状（症状清单）和神经认知功能（记忆，视觉词汇学习测试；注意力，斯特鲁普颜色-文字测试；处理速度，字母数字替代测试；一般认知，简易精神状态检查）。使用线性混合模型评估纵向关联。使用逻辑回归检查认知障碍，无痴呆（CIND）的风险。
调整年龄、性别、教育和基线认知后，记忆 z 分数的变化率分别为 0.00、-0.11、-0.20 和-0.37，在基线时处于最低（参考组）、第二、第三和最高抑郁症状四分位数的人分别为（最高与最低四分位比较，P<.001）。有遗忘特征的 CIND 发展的优势比分别为 1.00、0.87、0.69 和 2.98，用于四个严重程度组（最高与最低四分位比较，P=.05）。对于持续存在抑郁症状的人，关联最强，定义为基线和至少一次随访时存在高抑郁症状。处理速度和整体认知功能的结果相似，但注意力的结果则不那么强。未观察到 APOE 相互作用。
抑郁和 APOE 独立作用，增加认知下降的风险，可能为预防和早期治疗提供目标。
