Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Norway; Department of Geriatric Medicine, Oslo University Hospital, Norway.
Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Norway; Department of Geriatric Medicine, Oslo University Hospital, Norway.
J Affect Disord. 2017 Nov;222:146-152. doi: 10.1016/j.jad.2017.07.008. Epub 2017 Jul 8.
The relationship between progression of Alzheimer's disease and depression and its underlying mechanisms has scarcely been studied.
A sample of 282 outpatients with Alzheimer's disease (AD; 105 with amnestic AD and 177 with Alzheimer's dementia) from Norway were followed up for an average of two years. Assessment included Cornell Scale for Depression in Dementia and Clinical Dementia Rating Scale (CDR) at baseline and follow-up to examine the relationship between AD and depression. Additionally, MRI of the brain, CSF dementia biomarkers and APOE status were assessed at baseline. Progression of dementia was defined as the difference between CDR sum of boxes at follow-up and baseline (CDR-SB change). Trajectories of depressive symptoms on the Cornell Scale were identified using growth mixture modeling. Differences between the trajectories in regard to patients' characteristics were investigated.
Three distinct trajectories of depressive symptoms were identified: 231 (82.8%) of the patients had stable low-average scores on the Cornell Scale (Class 1); 11 (3.9%) had high and decreasing scores (Class 2); and 37 (13.3%) had moderate and increasing scores (Class 3). All classes had average probabilities over 80%, and confidence intervals were non-overlapping. The only significant characteristic associated with membership in class 3 was CDR-SB change.
Not all patients screened for participation were included in the study, but the included and non-included patients did not differ significantly. Some patients with amnestic MCI might have been misdiagnosed.
A more rapid progression of dementia was found in a group of patients with increasing depressive symptoms.
阿尔茨海默病（AD）的进展与抑郁及其潜在机制之间的关系鲜有研究。
本研究纳入了来自挪威的 282 名 AD 门诊患者（105 名遗忘型 AD 患者和 177 名阿尔茨海默病痴呆患者），平均随访 2 年。在基线和随访时采用 Cornell 痴呆抑郁量表和临床痴呆评定量表（CDR）评估，以评估 AD 与抑郁之间的关系。此外，还在基线时评估了脑 MRI、脑脊液痴呆生物标志物和 APOE 状态。痴呆的进展定义为随访时 CDR 总分与基线时的差值（CDR-SB 变化）。采用增长混合建模确定 Cornell 量表上抑郁症状的轨迹。并对各轨迹在患者特征方面的差异进行了调查。
共识别出 3 种不同的抑郁症状轨迹：231 名（82.8%）患者的 Cornell 量表评分稳定在低平均水平（1 类）；11 名（3.9%）患者的评分较高且逐渐下降（2 类）；37 名（13.3%）患者的评分中等且逐渐升高（3 类）。所有轨迹的平均概率均超过 80%，置信区间无重叠。唯一与 3 类轨迹相关的显著特征是 CDR-SB 变化。
并非所有筛选参加研究的患者均被纳入，但纳入和未纳入的患者无显著差异。一些遗忘型 MCI 患者可能被误诊。
在一组抑郁症状逐渐加重的患者中，痴呆的进展速度更快。
