Downer Brian, Vickers Benjamin N, Al Snih Soham, Raji Mukaila, Markides Kyriakos S
Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas.
Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas.
J Am Geriatr Soc. 2016 Jan;64(1):109-17. doi: 10.1111/jgs.13883.
To assess the relationship between comorbid depression, diabetes mellitus (DM), and cognitive decline in Mexican Americans aged 65 and older.
Retrospective cohort study with longitudinal analysis.
Texas, New Mexico, Colorado, Arizona, and California.
Hispanic Established Populations for the Epidemiologic Study of the Elderly.
Cognition was assessed using the Mini-Mental State Examination (MMSE). Depression was defined as a score of 16 or greater on the Center for Epidemiologic Studies Depression Scale. DM was defined as according to self-reported history or taking insulin or oral hypoglycemic medication.
Participants with depression and DM declined an average of 6.5 points on the MMSE; depression only, 4.4 points; DM only, 7.8 points; and neither condition, 4.2 points across the six examination waves. Participants with DM declined an average of 0.18 more points on the MMSE per year (P=.001) than those with neither DM nor depression, and those with comorbid DM and depression declined 0.25 more points per year (P=.002). Depression was associated with significantly greater cognitive decline (β^=-0.11, P=.05) after excluding participants with baseline cognitive impairment (MMSE score≤17). Participants with DM were 1.08 (95% CI=1.03-1.12) times as likely as those with neither DM nor depression, and those with comorbid DM and depression were 1.08 (95% CI=1.01-1.15) times as likely as those with neither DM nor depression to develop severe cognitive impairment per year.
DM and comorbid depression and DM are risk factors for cognitive decline in older Mexican Americans. Interventions that reduce the prevalence of depression and DM in Mexican Americans may decrease the number of older adults who experience cognitive decline.
评估65岁及以上墨西哥裔美国人中，共病抑郁症、糖尿病（DM）与认知功能减退之间的关系。
进行纵向分析的回顾性队列研究。
得克萨斯州、新墨西哥州、科罗拉多州、亚利桑那州和加利福尼亚州。
西班牙裔老年人流行病学研究的既定人群。
使用简易精神状态检查表（MMSE）评估认知功能。抑郁症定义为流行病学研究中心抑郁量表得分16分或更高。DM根据自我报告病史或服用胰岛素或口服降糖药来定义。
在六个检查周期中，患有抑郁症和DM的参与者MMSE平均下降6.5分；仅患有抑郁症的参与者下降4.4分；仅患有DM的参与者下降7.8分；两种情况都没有的参与者下降4.2分。患有DM的参与者每年MMSE平均比既没有DM也没有抑郁症的参与者多下降0.18分（P = 0.001），患有DM和抑郁症共病的参与者每年多下降0.25分（P = 0.002）。排除基线认知障碍（MMSE得分≤17）的参与者后，抑郁症与明显更大的认知功能减退相关（β^=-0.11，P = 0.05）。患有DM的参与者每年发生严重认知障碍的可能性是既没有DM也没有抑郁症的参与者的1.08倍（95%可信区间=1.03 - 1.12），患有DM和抑郁症共病的参与者每年发生严重认知障碍的可能性是既没有DM也没有抑郁症的参与者的1.08倍（95%可信区间=1.01 - 1.15）。
DM以及DM与抑郁症共病是老年墨西哥裔美国人认知功能减退的危险因素。降低墨西哥裔美国人中抑郁症和DM患病率的干预措施可能会减少经历认知功能减退的老年人数量。
