Cherbuin Nicolas, Kim Sarang, Anstey Kaarin J
Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia.
BMJ Open. 2015 Dec 21;5(12):e008853. doi: 10.1136/bmjopen-2015-008853.
To perform a systematic review of reported HRs of all cause dementia, Alzheimer's disease (AD) and vascular dementia (VaD) for late-life depression and depressive symptomatology on specific screening instruments at specific thresholds.
Meta-analysis with meta-regression.
PubMed, PsycInfo, and Cochrane databases were searched through 28 February 2014. Articles reporting HRs for incident all-cause dementia, AD and VaD based on published clinical criteria using validated measures of clinical depression or symptomatology from prospective studies of general population of adults were selected by consensus among multiple reviewers. Studies that did not use clinical dementia diagnoses or validated instruments for the assessment of depression were excluded. Data were extracted by two reviewers and reviewed by two other independent reviewers. The most specific analyses possible using continuous symptomatology ratings and categorical measures of clinical depression focusing on single instruments with defined reported cut-offs were conducted.
HRs for all-cause dementia, AD, and VaD were computed where possible for continuous depression scores, or for major depression assessed with single or comparable validated instruments.
Searches yielded 121,301 articles, of which 36 (0.03%) were eligible. Included studies provided a combined sample size of 66,532 individuals including 6593 cases of dementia, 2797 cases of AD and 585 cases of VaD. The increased risk associated with depression did not significantly differ by type of dementia and ranged from 83% to 104% for diagnostic thresholds consistent with major depression. Risk associated with continuous depression symptomatology measures were consistent with those for clinical thresholds.
Late-life depression is consistently and similarly associated with a twofold increased risk of dementia. The precise risk estimates produced in this study for specific instruments at specified thresholds will assist evidence-based medicine and inform policy on this important population health issue.
对特定筛查工具在特定阈值下报告的晚年抑郁及抑郁症状与全因性痴呆、阿尔茨海默病（AD）和血管性痴呆（VaD）的风险比（HR）进行系统评价。
Meta分析及Meta回归。
检索了截至2014年2月28日的PubMed、PsycInfo和Cochrane数据库。多位评审员经共识选择了基于已发表临床标准、使用来自成年普通人群前瞻性研究中经过验证的临床抑郁或症状测量方法报告全因性痴呆、AD和VaD发病HR的文章。未使用临床痴呆诊断或未经验证的抑郁评估工具的研究被排除。由两名评审员提取数据，并由另外两名独立评审员进行审核。采用连续症状评分和临床抑郁分类测量方法，针对具有明确报告临界值的单一工具进行了尽可能具体的分析。
尽可能计算连续抑郁评分或使用单一或可比的经过验证的工具评估的重度抑郁的全因性痴呆、AD和VaD的HR。
检索到121,301篇文章，其中36篇（0.03%）符合纳入标准。纳入研究的样本总量为66,532人，其中包括6593例痴呆、2797例AD和585例VaD。与抑郁相关的风险增加在不同类型痴呆中无显著差异，与重度抑郁一致的诊断阈值下的风险范围为83%至104%。与连续抑郁症状测量相关的风险与临床阈值的风险一致。
晚年抑郁与痴呆风险增加两倍始终且类似相关。本研究针对特定工具在特定阈值下得出的精确风险估计将有助于循证医学，并为这一重要的人群健康问题提供政策依据。
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