Georgakis Marios K, Papadopoulos Fotios C, Protogerou Athanasios D, Pagonari Ioanna, Sarigianni Fani, Biniaris-Georgallis Stylianos-Iason, Kalogirou Eleni Ι, Thomopoulos Thomas P, Kapaki Elisabeth, Papageorgiou Charalampos, Papageorgiou Socratis G, Tousoulis Dimitrios, Petridou Eleni Th
Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece.
Department of Neuroscience, Psychiatry, Uppsala University, Uppsala University Hospital, Athens, Greece.
J Geriatr Psychiatry Neurol. 2016 Jul;29(4):195-204. doi: 10.1177/0891988716632913. Epub 2016 Feb 25.
To investigate the association of cognitive impairment (COGI) and depression with all-cause mortality and cardiovascular-specific mortality among community-dwelling elderly individuals in rural Greece.
Cognition and depressive symptomatology of 676 Velestino town residents aged ≥60 years were assessed using Mini-Mental State Examination (MMSE) and Geriatric Depression Scale (GDS), respectively. Eight-year all-cause mortality and cardiovascular mortality were explored by multivariate Cox regression models controlling for major confounders.
Two hundred and one patients died during follow-up. Cognitive impairment (MMSE ≤ 23) was independently associated with all-cause mortality (hazard ratio [HR]: 1.57, 95% confidence interval [CI]: 1.13-2.18) and cardiovascular mortality (HR: 1.57, 95%CI: 1.03-2.41). Moderate to severe depression (GDS > 10) was significantly associated only with a 51% increase in all-cause mortality. A male-specific association was noted for moderate to severe depression, whereas the effect of COGI was limited to females. Noteworthy, COGI and depression comorbidity, rather than their sole presence, increased all-cause mortality and cardiovascular mortality by 66% and 72%, respectively. The mortality effect of COGI was augmented among patients with depression and of depression among patients with COGI.
COGI and depression, 2 entities often coexisting among elderly individuals, appear to increase all-cause mortality and cardiovascular mortality. Gender-specific modes may prevail but their comorbidity should be carefully assessed, as it seems to represent an independent index of increased frailty, which eventually shortens life expectancy.
调查希腊农村社区居住的老年人中认知障碍和抑郁症与全因死亡率及心血管疾病特异性死亡率之间的关联。
分别使用简易精神状态检查表（MMSE）和老年抑郁量表（GDS）对676名年龄≥60岁的韦莱斯蒂诺镇居民的认知和抑郁症状进行评估。通过控制主要混杂因素的多变量Cox回归模型探讨8年全因死亡率和心血管疾病死亡率。
随访期间有201名患者死亡。认知障碍（MMSE≤23）与全因死亡率（风险比[HR]：1.57，95%置信区间[CI]：1.13 - 2.18）和心血管疾病死亡率（HR：1.57，95%CI：1.03 - 2.41）独立相关。中度至重度抑郁症（GDS>10）仅与全因死亡率显著增加51%相关。中度至重度抑郁症存在男性特异性关联，而认知障碍的影响仅限于女性。值得注意的是，认知障碍和抑郁症共病，而非单独存在，分别使全因死亡率和心血管疾病死亡率增加了66%和72%。认知障碍对死亡率的影响在抑郁症患者中增强，而抑郁症对死亡率的影响在认知障碍患者中增强。
认知障碍和抑郁症这两个在老年人中常并存的情况，似乎会增加全因死亡率和心血管疾病死亡率。可能存在性别特异性模式，但应仔细评估它们的共病情况，因为这似乎代表了虚弱增加的一个独立指标，最终会缩短预期寿命。
