Singh-Manoux Archana, Dugravot Aline, Fournier Agnes, Abell Jessica, Ebmeier Klaus, Kivimäki Mika, Sabia Séverine
INSERM U1018, Centre for Research in Epidemiology and Population Health, Paris, France2Department of Epidemiology and Public Health, University College London, London, England.
INSERM U1018, Centre for Research in Epidemiology and Population Health, Paris, France.
JAMA Psychiatry. 2017 Jul 1;74(7):712-718. doi: 10.1001/jamapsychiatry.2017.0660.
Neuropsychiatric symptoms, depressive symptoms in particular, are common in patients with dementia but whether depressive symptoms in adulthood increases the risk for dementia remains the subject of debate.
To characterize the trajectory of depressive symptoms over 28 years prior to dementia diagnosis to determine whether depressive symptoms carry risk for dementia.
DESIGN, SETTING, AND PARTICIPANTS: Up to 10 308 persons, aged 35 to 55 years, were recruited to the Whitehall II cohort study in 1985, with the end of follow-up in 2015. Data analysis for this study in a UK general community was conducted from October to December 2016.
Depressive symptoms assessed on 9 occasions between 1985 and 2012 using the General Health Questionnaire.
Incidence of dementia (n = 322) between 1985 and 2015.
Of the 10 189 persons included in the study, 6838 were men (67%) and 3351 were women (33%). Those reporting depressive symptoms in 1985 (mean follow-up, 27 years) did not have significantly increased risk for dementia (hazard ratio [HR], 1.21; 95% CI, 0.95-1.54) in Cox regression adjusted for sociodemographic covariates, health behaviors, and chronic conditions. However, those with depressive symptoms in 2003 (mean follow-up, 11 years) had an increased risk (HR, 1.72; 95% CI, 1.21-2.44). Those with chronic/recurring depressive symptoms (≥2 of 3 occasions) in the early study phase (mean follow-up, 22 years) did not have excess risk (HR, 1.02; 95% CI, 0.72-1.44) but those with chronic/recurring symptoms in the late phase (mean follow-up, 11 years) did have higher risk for dementia (HR, 1.67; 95% CI, 1.11-2.49). Analysis of retrospective depressive trajectories over 28 years, using mixed models and a backward time scale, shows that in those with dementia, differences in depressive symptoms compared with those without dementia became apparent 11 years (difference, 0.61; 95% CI, 0.09-1.13; P = .02) before dementia diagnosis and became more than 9 times larger at the year of diagnosis (difference, 5.81; 95% CI, 4.81-6.81; P < .001).
Depressive symptoms in the early phase of the study corresponding to midlife, even when chronic/recurring, do not increase the risk for dementia. Along with our analysis of depressive trajectories over 28 years, these results suggest that depressive symptoms are a prodromal feature of dementia or that the 2 share common causes. The findings do not support the hypothesis that depressive symptoms increase the risk for dementia.
神经精神症状，尤其是抑郁症状，在痴呆症患者中很常见，但成年期的抑郁症状是否会增加患痴呆症的风险仍是一个有争议的话题。
描述痴呆症诊断前28年抑郁症状的变化轨迹，以确定抑郁症状是否会增加患痴呆症的风险。
设计、背景和参与者：1985年，多达10308名年龄在35至55岁之间的人被纳入白厅II队列研究，随访于2015年结束。2016年10月至12月对英国普通社区的这项研究进行了数据分析。
1985年至2012年期间，使用一般健康问卷对抑郁症状进行了9次评估。
1985年至2015年期间痴呆症的发病率（n = 322）。
在纳入研究的10189人中，6838人为男性（67%），3351人为女性（33%）。在对社会人口统计学协变量、健康行为和慢性病进行Cox回归调整后，1985年报告有抑郁症状的人（平均随访27年）患痴呆症的风险没有显著增加（风险比[HR]，1.21；95%置信区间，0.95 - 1.54）。然而，2003年有抑郁症状的人（平均随访11年）风险增加（HR，1.72；95%置信区间，1.21 - 2.44）。在研究早期阶段（平均随访22年）有慢性/复发性抑郁症状（3次中有≥2次）的人没有额外风险（HR，1.02；95%置信区间，0.72 - 1.44），但在后期阶段（平均随访11年）有慢性/复发性症状的人患痴呆症的风险更高（HR，1.67；95%置信区间，1.11 - 2.49）。使用混合模型和反向时间尺度对28年的回顾性抑郁轨迹进行分析表明，在患有痴呆症的人中，与未患痴呆症的人相比，抑郁症状的差异在痴呆症诊断前11年就变得明显（差异，0.61；95%置信区间，0.09 - 1.13；P = 0.02），并在诊断当年增加到9倍以上（差异，5.81；95%置信区间，4.81 - 6.81；P < 0.001）。
在对应中年的研究早期阶段，即使是慢性/复发性的抑郁症状也不会增加患痴呆症的风险。结合我们对28年抑郁轨迹的分析，这些结果表明抑郁症状是痴呆症的前驱特征，或者两者有共同的病因。这些发现不支持抑郁症状会增加患痴呆症风险的假设。
