Holmes Sophie E, Esterlis Irina, Mazure Carolyn M, Lim Yen Ying, Ames David, Rainey-Smith Stephanie, Fowler Chris, Ellis Kathryn, Martins Ralph N, Salvado Olivier, Doré Vincent, Villemagne Victor L, Rowe Christopher C, Laws Simon M, Masters Colin L, Pietrzak Robert H, Maruff Paul
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
The Florey Institute, The University of Melbourne, Parkville, Victoria, Australia.
Int J Geriatr Psychiatry. 2018 Feb;33(2):405-413. doi: 10.1002/gps.4761. Epub 2017 Jul 24.
Depressive and anxiety symptoms are common in older adults, significantly affect quality of life, and are risk factors for Alzheimer's disease. We sought to identify the determinants of predominant trajectories of depressive and anxiety symptoms in cognitively normal older adults.
Four hundred twenty-three older adults recruited from the general community underwent Aβ positron emission tomography imaging, apolipoprotein and brain-derived neurotrophic factor genotyping, and cognitive testing at baseline and had follow-up assessments. All participants were cognitively normal and free of clinical depression at baseline. Latent growth mixture modeling was used to identify predominant trajectories of subthreshold depressive and anxiety symptoms over 6 years. Binary logistic regression analysis was used to identify baseline predictors of symptomatic depressive and anxiety trajectories.
Latent growth mixture modeling revealed two predominant trajectories of depressive and anxiety symptoms: a chronically elevated trajectory and a low, stable symptom trajectory, with almost one in five participants falling into the elevated trajectory groups. Male sex (relative risk ratio (RRR) = 3.23), lower attentional function (RRR = 1.90), and carriage of the brain-derived neurotrophic factor Val66Met allele in women (RRR = 2.70) were associated with increased risk for chronically elevated depressive symptom trajectory. Carriage of the apolipoprotein epsilon 4 allele (RRR = 1.92) and lower executive function in women (RRR = 1.74) were associated with chronically elevated anxiety symptom trajectory.
Our results indicate distinct and sex-specific risk factors linked to depressive and anxiety trajectories, which may help inform risk stratification and management of these symptoms in older adults at risk for Alzheimer's disease. Copyright © 2017 John Wiley & Sons, Ltd.
抑郁和焦虑症状在老年人中很常见，会显著影响生活质量，并且是阿尔茨海默病的危险因素。我们试图确定认知正常的老年人中抑郁和焦虑症状主要轨迹的决定因素。
从普通社区招募的423名老年人在基线时接受了淀粉样蛋白β正电子发射断层扫描成像、载脂蛋白和脑源性神经营养因子基因分型以及认知测试，并进行了随访评估。所有参与者在基线时认知正常且无临床抑郁症。使用潜在增长混合模型来确定6年内阈下抑郁和焦虑症状的主要轨迹。二元逻辑回归分析用于确定有症状的抑郁和焦虑轨迹的基线预测因素。
潜在增长混合模型揭示了抑郁和焦虑症状的两种主要轨迹：慢性升高轨迹和低水平、稳定症状轨迹，近五分之一的参与者属于升高轨迹组。男性（相对风险比（RRR）=3.23）、注意力功能较低（RRR=1.90）以及女性携带脑源性神经营养因子Val66Met等位基因（RRR=2.70）与慢性升高的抑郁症状轨迹风险增加相关。携带载脂蛋白ε4等位基因（RRR=1.92）和女性执行功能较低（RRR=1.74）与慢性升高的焦虑症状轨迹相关。
我们的结果表明与抑郁和焦虑轨迹相关的不同且具有性别特异性的危险因素，这可能有助于为有患阿尔茨海默病风险的老年人中这些症状的风险分层和管理提供信息。版权所有©2017约翰威立父子有限公司。
