Department of Neurociences, University of Lisbon, Santa Maria Hospital, , Lisbon, Portugal.
J Neurol Neurosurg Psychiatry. 2013 Nov;84(11):1250-4. doi: 10.1136/jnnp-2012-304191. Epub 2013 May 28.
Depressive symptoms (DS) have been associated with increased risk of cognitive decline. Our aim was to evaluate the longitudinal influence of DS on cognition in independent older people, accounting for the severity of white matter changes (WMC).
The LADIS (Leukoaraiosis And DISability in the elderly) prospective study evaluated the impact of WMC on the transition of independent older subjects into disability. Subjects were evaluated annually over a 3 year period with a comprehensive clinical and neuropsychological evaluation. Previous episodes of depression and current DS were assessed during each interview. Severity of DS was assessed using the self-rated 15 item Geriatric Depression Scale. A neuropsychological battery and clinical criteria for cognitive impairments were applied in all clinical visits, and cognitive compound measures were made based on neuropsychological results. MRI was performed at baseline and at year 3.
639 subjects were included (74.1 ± 5 years old, 55% women, 9.6 ± 3.8 years of schooling). Dementia was diagnosed in 90 patients and cognitive impairment not dementia in 147 patients at the last clinical evaluation. DS were an independent predictor of cognitive impairment (dementia and not dementia) during follow-up, independent of the effect of the severity of WMC, medial temporal lobe atrophy, age, education or global cognitive function at baseline.
DS are associated with an increase risk of cognitive decline, independent of the effect of WMC, probably due to an additive or synergistic effect. In this context, DS probably represent a subtle ongoing organic dysfunction.
抑郁症状（DS）与认知能力下降的风险增加有关。我们的目的是评估 DS 对独立老年人认知的纵向影响，同时考虑到白质变化（WMC）的严重程度。
LADIS（老年人白质病变和残疾）前瞻性研究评估了 WMC 对独立老年人从无残疾到残疾的转变的影响。在 3 年的时间里，每年对受试者进行一次全面的临床和神经心理学评估。在每次访谈中评估过去的抑郁发作和当前的 DS。DS 的严重程度使用自评的 15 项老年抑郁量表进行评估。在所有临床就诊中应用神经心理学测试和认知障碍的临床标准，并根据神经心理学结果制定认知综合指标。在基线和第 3 年进行 MRI。
共纳入 639 名受试者（74.1±5 岁，55%为女性，9.6±3.8 年受教育年限）。在最后一次临床评估中，90 名患者被诊断为痴呆，147 名患者被诊断为认知障碍但非痴呆。DS 是随访期间认知障碍（痴呆和非痴呆）的独立预测因素，独立于 WMC、内侧颞叶萎缩、年龄、教育或基线时整体认知功能的影响。
DS 与认知能力下降的风险增加有关，独立于 WMC 的影响，可能是由于附加或协同作用。在这种情况下，DS 可能代表一种微妙的持续的有机功能障碍。
