Western Australian Centre for Health & Ageing (M573), Centre for Medical Research, University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA 6009, Australia; School of Psychiatry and Clinical Neurosciences, University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA 6009, Australia; Department of Psychiatry, Royal Perth Hospital, 50 Murray Street, Perth, WA 6000, Australia.
Western Australian Centre for Health & Ageing (M573), Centre for Medical Research, University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA 6009, Australia; School of Medicine and Pharmacology, University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA 6009, Australia.
J Affect Disord. 2013 Nov;151(2):646-651. doi: 10.1016/j.jad.2013.07.012. Epub 2013 Aug 5.
Depression and high total plasma homocysteine (tHcy) are independently associated with cognitive impairment in older adults. We designed this study to determine if high tHcy is a mediator of cognitive performance in older adults with major depression.
We recruited 358 community-dwelling older adults experiencing depressive symptoms, 236 (65.9%) of who met DSM-IV-TR criteria for major depression. Assessment included the Montgomery Asberg Depression Rating Scale (MADRS), fasting tHcy and the Consortium to Establish a Registry for Alzheimer's Disease neuropsychological battery.
Individuals with major depression and high tHcy had significantly worse immediate verbal and delayed visual recall. Non-depressed participants with high tHcy had lower MMSE, immediate and delayed recall scores than those with normal tHcy. The odds of cognitive inefficiency for those with high tHcy was nearly doubled for the MMSE (OR 1.9, 95%CI 1.1-3.3), immediate (OR 1.9, 95%CI 1.1-3.5) and delayed (OR 1.9, 95%CI 1.1-3.4) word recall after adjusting for age, gender, IHD and MADRS score.
The presence of sub-syndromal depressive symptoms in our non-depressed group and exclusion of participants with established cognitive impairment may limit the generalizability of this study.
Elevated tHcy was associated with weaker performance in tests of immediate and delayed memory and global cognitive performance when compared to those with normal tHcy independent of the presence of major depression or the severity of depressive symptoms. Homocysteine lowering B-vitamin supplementation may offer a potential therapeutic target to try and mitigate the often-disabling impact of cognitive deficits found in this population.
抑郁和高总血浆同型半胱氨酸（tHcy）与老年人的认知障碍独立相关。我们设计了这项研究，以确定高 tHcy 是否是老年抑郁症患者认知表现的中介。
我们招募了 358 名有抑郁症状的社区居住的老年人，其中 236 名（65.9%）符合 DSM-IV-TR 重性抑郁障碍标准。评估包括蒙哥马利抑郁评定量表（MADRS）、空腹 tHcy 和认知障碍协会建立的阿尔茨海默病神经心理成套测验。
患有重性抑郁症和高 tHcy 的个体即时言语和延迟视觉回忆明显更差。高 tHcy 的非抑郁参与者的 MMSE、即时和延迟回忆得分低于正常 tHcy 的参与者。高 tHcy 者认知效率低下的可能性 MMSE（OR 1.9，95%CI 1.1-3.3）、即时（OR 1.9，95%CI 1.1-3.5）和延迟（OR 1.9，95%CI 1.1-3.4）单词回忆，调整年龄、性别、冠心病和 MADRS 评分后。
我们非抑郁组中存在亚综合征性抑郁症状以及排除已确诊认知障碍的参与者可能限制了本研究的普遍性。
与正常 tHcy 相比，高 tHcy 与即时和延迟记忆以及整体认知表现测试中的表现较弱相关，独立于重性抑郁症的存在或抑郁症状的严重程度。降低同型半胱氨酸的 B 族维生素补充可能提供一个潜在的治疗靶点，试图减轻在这一人群中发现的认知缺陷的常见致残影响。
