Sachs-Ericsson Natalie, Moxley Jerad H, Corsentino Elizabeth, Rushing Nicole Collins, Sheffler Julia, Selby Edward A, Gotlib Ian, Steffens David C
Department of Psychology, Florida State University, Tallahassee, FL, USA.
Int J Geriatr Psychiatry. 2014 Sep;29(9):943-51. doi: 10.1002/gps.4083. Epub 2014 Feb 12.
Depression is a risk factor for cognitive decline and dementia. This risk may vary with age of onset and depression subtype. Late onset depression (LOD, 60 years and older) is associated with more cognitive decline, whereas early onset depression (EOD, before 60 years) is associated with more residual depressive symptoms. Potential differences may reflect divergent etiologies. These onset differences, however, have not been examined in the melancholic subtype of depression in older adults.
Data were obtained from the Neurocognitive Outcomes of Depression in the Elderly study. Participants (N = 284, 73% EOD-melancholic (EOD-M) and 27% LOD-melancholic (LOD-M)) were followed up over 3 years. Factor analyses examined differences in baseline depressive symptoms. Hierarchical linear growth curve models examined changes in depressive symptoms (Montgomery-Asberg Depression Rating Scale) and cognition (mini mental state examination). An annual clinical review panel assigned diagnoses of dementia.
The LOD-M participants had more vegetative symptoms at baseline. LOD-M exhibited greater cognitive decline but fewer residual depressive symptoms than EOD-M. Among participants who remained in the study for at least 1 year, in uncontrolled analyses, a greater percentage of LOD-M compared with EOD-M developed dementia (23.0% vs. 7.8%). Whereas in logistic analyses, controlling for baseline demographics, age at onset remained a predictor of dementia, the odds ratio suggested that the effect was relatively small.
The EOD-M and LOD-M participants have a different presentation and course. LOD-M may represent a syndrome of neuropsychiatric deterioration with expression of both depressive symptoms and cognitive decline.
抑郁症是认知功能下降和痴呆的一个风险因素。这种风险可能因发病年龄和抑郁亚型而异。晚发性抑郁症（LOD，60岁及以上）与更多的认知功能下降相关，而早发性抑郁症（EOD，60岁之前）与更多的残留抑郁症状相关。潜在差异可能反映了不同的病因。然而，这些发病差异尚未在老年抑郁症的 melancholic 亚型中进行研究。
数据来自老年抑郁症的神经认知结局研究。对参与者（N = 284，73% 为早发性 melancholic 抑郁症（EOD-M），27% 为晚发性 melancholic 抑郁症（LOD-M））进行了3年的随访。因子分析检查了基线抑郁症状的差异。分层线性生长曲线模型检查了抑郁症状（蒙哥马利-阿斯伯格抑郁量表）和认知（简易精神状态检查）的变化。一个年度临床审查小组对痴呆进行诊断。
LOD-M 参与者在基线时有更多的躯体症状。与 EOD-M 相比，LOD-M 表现出更大的认知功能下降，但残留抑郁症状更少。在至少参加研究1年的参与者中，在未进行控制的分析中，与 EOD-M 相比，LOD-M 发展为痴呆的比例更高（23.0% 对 7.8%）。而在逻辑分析中，在控制了基线人口统计学因素后，发病年龄仍然是痴呆的一个预测因素，优势比表明这种影响相对较小。
EOD-M 和 LOD-M 参与者有不同的表现和病程。LOD-M 可能代表一种神经精神恶化综合征，既有抑郁症状的表现，又有认知功能下降。
