King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom.
King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom.
J Am Med Dir Assoc. 2017 Dec 1;18(12):1076-1081. doi: 10.1016/j.jamda.2017.07.001. Epub 2017 Aug 31.
Depression is associated with increased mortality in community samples. The use of antidepressant medication may also increase mortality, however, it is still unclear whether taking antidepressants before or after a diagnosis of dementia influences survival.
Retrospective.
A cohort with a diagnosis of Alzheimer disease (AD) from a large mental health and dementia care database in South London, linked to hospitalization and mortality data.
Mild dementia (Mini-Mental State Examination ≥18/30) at the point of diagnosis.
We ascertained antidepressant prescription, either in the 6 months before or after dementia diagnosis, and used the HoNOS65+, a standard clinician-rated measure of patient well-being, to determine depression severity and other neuropsychiatric, physical health, and functional difficulties. We conducted a survival analysis, adjusted for potential confounders and addressed possible confounding by indication through adjusting for a propensity score.
Of 5473 patients with AD, 22.8% were prescribed an antidepressant in a 1-year window around dementia diagnosis. Of these, 2415 (44.1%) died in the follow-up period [mean (standard deviation) 3.5 (2.4) years]. Prescription of an antidepressant, both before and after dementia diagnosis, was significantly associated with higher mortality after adjusting for a broad range of potential confounders including symptom severity, functional status, and physical illness (hazard ratio 1.22; 95% confidence interval 1.08-1.37 for prescription prior to dementia diagnosis; 95% confidence interval 1.04-1.45 for prescription post dementia diagnosis). In stratified analyses, risks remained significant in those without neuropsychiatric symptoms.
The prescription of antidepressants around the time of dementia diagnosis may be a risk factor for mortality.
在社区样本中，抑郁与死亡率升高相关。使用抗抑郁药物也可能增加死亡率，但在痴呆症诊断之前或之后使用抗抑郁药是否影响生存仍不清楚。
回顾性研究。
伦敦南部一个大型精神卫生和痴呆症护理数据库中的阿尔茨海默病（AD）诊断队列，与住院和死亡率数据相关联。
在诊断时为轻度痴呆症（Mini-Mental State Examination ≥18/30）。
我们确定了抗抑郁药的处方，无论是在痴呆症诊断前还是后 6 个月内，并使用 HoNOS65+，一种标准的临床医生评定患者健康状况的测量方法，来确定抑郁严重程度和其他神经精神病、身体健康和功能障碍。我们进行了生存分析，调整了潜在的混杂因素，并通过调整倾向评分来解决可能的混杂因素。
在 5473 名 AD 患者中，有 22.8%在痴呆症诊断前后的 1 年窗口期内开了抗抑郁药。在这些患者中，有 2415 人（44.1%）在随访期间死亡（平均[标准差]3.5[2.4]年）。在调整了广泛的潜在混杂因素后，包括症状严重程度、功能状态和身体疾病，无论是在痴呆症诊断前还是后开抗抑郁药，与更高的死亡率显著相关（痴呆症诊断前处方的风险比 1.22；95%置信区间 1.08-1.37；痴呆症诊断后处方的风险比 1.04-1.45）。在分层分析中，在没有神经精神病症状的患者中，风险仍然显著。
在痴呆症诊断时开抗抑郁药可能是死亡的一个危险因素。
