Departments of Psychiatry, University of California, San Francisco, USA.
Am J Geriatr Psychiatry. 2012 Aug;20(8):664-72. doi: 10.1097/JGP.0b013e31822001c1.
To determine whether less severe depression spectrum diagnoses such as dysthymia, as well as depression, are associated with risk of developing dementia and mortality in a "real-world" setting.
Retrospective cohort study conducted using the Department of Veterans Affairs (VA) National Patient Care Database (1997-2007).
VA medical centers in the United States.
A total of 281,540 veterans aged 55 years and older without dementia at study baseline (1997-2000).
Depression status and incident dementia were ascertained from International Classification of Diseases, Ninth Revision codes during study baseline (1997-2000) and follow-up (2001-2007), respectively. Mortality was ascertained by time of death dates in the VA Vital Status File.
Ten percent of veterans had baseline diagnosis of depression and nearly 1% had dysthymia. The unadjusted incidence of dementia was 11.2% in veterans with depression, 10.2% with dysthymia and 6.4% with neither. After adjusting for demographics and comorbidities, patients diagnosed with dysthymia or depression were twice as likely to develop incident dementia compared with those with no dysthymia/depression (adjusted dysthymia hazard ratio [HR]: 1.96, 95% confidence interval [CI]: 1.71-2.25; and depression HR: 2.18, 95% CI: 2.08-2.28). Dysthymia and depression also were associated with increased risk of death (31.6% dysthymia and 32.9% depression versus 28.5% neither; adjusted dysthymia HR: 1.41, 95% CI: 1.31-1.53; and depression HR: 1.47, 95% CI: 1.43-1.51).
Findings suggest that older adults with dysthymia or depression need to be monitored closely for adverse outcomes. Future studies should determine whether treatment of depression spectrum disorders may reduce risk of these outcomes.
在“真实世界”环境中，确定较轻的抑郁谱诊断（如心境恶劣，以及抑郁症）是否与痴呆和死亡风险相关。
使用退伍军人事务部（VA）国家患者护理数据库（1997-2007 年）进行的回顾性队列研究。
美国 VA 医疗中心。
共纳入 281540 名年龄在 55 岁及以上、基线时无痴呆的退伍军人（1997-2000 年）。
在基线（1997-2000 年）和随访（2001-2007 年）期间，分别使用国际疾病分类第 9 版代码确定抑郁状态和新发痴呆。通过 VA 生命状况档案中的死亡日期确定死亡率。
10%的退伍军人有基线诊断的抑郁症，近 1%的退伍军人有心境恶劣。患有抑郁症、心境恶劣和既无心境恶劣也无抑郁症的退伍军人的痴呆发生率分别为 11.2%、10.2%和 6.4%。调整人口统计学和合并症后，与无心境恶劣/抑郁症的退伍军人相比，被诊断为心境恶劣或抑郁症的患者发生新发痴呆的风险增加了两倍（心境恶劣的调整后风险比[HR]：1.96，95%置信区间[CI]：1.71-2.25；抑郁症的 HR：2.18，95% CI：2.08-2.28）。心境恶劣和抑郁症也与死亡风险增加相关（心境恶劣为 31.6%，抑郁症为 32.9%，而既无心境恶劣也无抑郁症为 28.5%；心境恶劣的调整后 HR：1.41，95% CI：1.31-1.53；抑郁症的 HR：1.47，95% CI：1.43-1.51）。
研究结果表明，心境恶劣或抑郁症的老年患者需要密切监测不良结局。未来的研究应确定治疗抑郁谱障碍是否可以降低这些结局的风险。
