Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
Int Psychogeriatr. 2012 Aug;24(8):1252-64. doi: 10.1017/S1041610211002778. Epub 2012 Feb 3.
Antidepressants are commonly prescribed medications in the elderly, but their relationship with incident mild cognitive impairment (MCI) and probable dementia is unknown.
The study cohort included 6,998 cognitively healthy, postmenopausal women, aged 65-79 years, who were enrolled in a hormone therapy clinical trial and had baseline depressive symptoms and antidepressant use history assessments at enrollment, and at least one postbaseline cognitive measurement. Participants were followed annually and the follow-up averaged 7.5 years for MCI and probable dementia outcomes. A central adjudication committee classified the presence of MCI and probable dementia based on extensive neuropsychiatric examination.
Three hundred and eighty-three (5%) women were on antidepressants at baseline. Antidepressant use was associated with a 70% increased risk of MCI, after controlling for potential covariates including the degree of depressive symptom severity. Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) were both associated with MCI (SSRIs: hazard ratios (HR), 1.78 [95% CI, 1.01-3.13]; TCAs: HR, 1.78 [95% CI, 0.99-3.21]). Depressed users (HR, 2.44 [95% CI, 1.24-4.80]), non-depressed users (HR, 1.79 [95% CI, 1.13-2.85]), and depressed non-users (HR, 1.62 [95% CI, 1.13-2.32]) had increased risk of incident MCI. Similarly, all three groups had increased risk of either MCI or dementia, relative to the control cohort.
Antidepressant use and different levels of depression severity were associated with subsequent cognitive impairment in a large cohort of postmenopausal women. Future research should examine the role of antidepressants in the depression-dementia relationship and determine if antidepressants can prevent incident MCI and dementia in individuals with late-life depression subtypes with different levels of severity.
抗抑郁药是老年人常用的处方药物，但它们与轻度认知障碍（MCI）和可能的痴呆症的关系尚不清楚。
研究队列包括 6998 名认知健康、绝经后的女性，年龄在 65-79 岁之间，她们参加了一项激素治疗临床试验，在入组时和基线后至少进行了一次认知测量时，进行了基线抑郁症状和抗抑郁药物使用情况评估。参与者每年接受随访，平均随访时间为 7.5 年，以评估 MCI 和可能的痴呆症结果。一个中央裁决委员会根据广泛的神经精神检查来确定 MCI 和可能的痴呆症的存在。
383 名（5%）女性在基线时正在服用抗抑郁药。在控制了包括抑郁症状严重程度在内的潜在混杂因素后，抗抑郁药的使用与 MCI 的风险增加 70%相关。选择性 5-羟色胺再摄取抑制剂（SSRIs）和三环类抗抑郁药（TCAs）都与 MCI 相关（SSRIs：危险比（HR），1.78 [95%置信区间，1.01-3.13]；TCAs：HR，1.78 [95%置信区间，0.99-3.21]）。抑郁使用者（HR，2.44 [95%置信区间，1.24-4.80]）、非抑郁使用者（HR，1.79 [95%置信区间，1.13-2.85]）和抑郁非使用者（HR，1.62 [95%置信区间，1.13-2.32]）发生 MCI 的风险增加。同样，与对照组相比，所有三组发生 MCI 或痴呆症的风险都增加。
在一大群绝经后妇女中，抗抑郁药的使用和不同程度的抑郁严重程度与随后的认知障碍有关。未来的研究应该检查抗抑郁药在抑郁-痴呆症关系中的作用，并确定抗抑郁药是否可以预防不同严重程度的迟发性抑郁症亚型个体发生 MCI 和痴呆症。
