Potter Guy G, McQuoid Douglas R, Whitson Heather E, Steffens David C
Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA.
Int J Geriatr Psychiatry. 2016 May;31(5):466-74. doi: 10.1002/gps.4351. Epub 2015 Aug 27.
The aim of this study was to examine the association between physical frailty and neurocognitive performance in late-life depression (LLD).
Cross-sectional design using baseline data from a treatment study of late-life depression was used in this study. Individuals aged 60 years and older were diagnosed with major depressive disorder at time of assessment (N = 173). All participants received clinical assessment of depression and completed neuropsychological testing during a depressive episode. Physical frailty was assessed using an adaptation of the FRAIL scale. Neuropsychological domains were derived from a factor analysis that yielded three factors: (i) speeded executive and fluency, (ii) episodic memory, and (iii) working memory. Associations were examined with bivariate tests and multivariate models.
Depressed individuals with a FRAIL score >1 had worse performance than nonfrail depressed across all three factors; however, speeded executive and fluency was the only factor that remained significant after controlling for depression symptom severity and demographic characteristics.
Although physical frailty is associated with broad neurocognitive deficits in LLD, it is most robustly associated with deficits in speeded executive functions and verbal fluency. Causal inferences are limited by the cross-sectional design, and future research would benefit from a comparison group of nondepressed older adults with similar levels of frailty. Research is needed to understand the mechanisms underlying associations among depression symptoms, physical frailty, and executive dysfunction and how they are related to the cognitive and symptomatic course of LLD.
本研究旨在探讨老年抑郁症（LLD）患者身体虚弱与神经认知表现之间的关联。
本研究采用横断面设计，使用来自一项老年抑郁症治疗研究的基线数据。60岁及以上的个体在评估时被诊断为重度抑郁症（N = 173）。所有参与者均接受了抑郁症的临床评估，并在抑郁发作期间完成了神经心理学测试。使用FRAIL量表的改编版评估身体虚弱程度。神经心理学领域来自一项因素分析，该分析产生了三个因素：（i）快速执行和流畅性，（ii）情景记忆，以及（iii）工作记忆。通过双变量检验和多变量模型检验关联。
FRAIL评分>1的抑郁个体在所有三个因素上的表现均比非虚弱抑郁个体差；然而，在控制了抑郁症状严重程度和人口统计学特征后，快速执行和流畅性是唯一仍具有显著意义的因素。
虽然身体虚弱与老年抑郁症患者广泛的神经认知缺陷有关，但它与快速执行功能和语言流畅性缺陷的关联最为强烈。因果推断受横断面设计的限制，未来的研究将受益于一组具有相似虚弱水平的非抑郁老年人的比较组。需要开展研究以了解抑郁症状、身体虚弱和执行功能障碍之间关联的潜在机制，以及它们如何与老年抑郁症的认知和症状过程相关。
