Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney, Australia.
Psychol Med. 2019 Oct;49(13):2168-2176. doi: 10.1017/S0033291718002994. Epub 2018 Oct 29.
It has been proposed that vascular disease is the mechanism linking depression and cognition, but prospective studies have not supported this hypothesis. This study aims to investigate the inter-relationships between depressive symptoms, cognition and cerebrovascular disease using a well-characterised prospective cohort.
Data came from waves 1 (2005-2007) and 2 (2007-2009) of the Sydney Memory and Ageing Study (n = 462; mean age = 78.3 years).
At wave 1, there was an association between depressive symptoms and white matter hyperintensity (WMH) volume [b = 0.016, t(414) = 2.34, p = 0.020]. Both depressive symptoms [b = -0.058, t(413) = -2.64, p = 0.009] and WMH volume [b = -0.011, t(413) = -3.77, p < 0.001], but not stroke/transient ischaemic attack (TIA) [b = -0.328, t(413) = -1.90, p = 0.058], were independently associated with lower cognition. Prospectively, cerebrovascular disease was not found to predict increasing depressive symptoms [stroke/TIA: b = -0.349, t(374.7) = -0.76, p = 0.448; WMH volume: b = 0.007, t(376.3) = 0.875, p = 0.382]. Depressive symptoms predicted increasing WMH severity [b = 0.012, t(265.9) = -3.291, p = 0.001], but not incident stroke/TIA (odds ratio = 0.995; CI 0.949-1.043; p = 0.820). When examined in separate models, depressive symptoms [b = -0.027, t(373.5) = -2.16, p = 0.032] and a history of stroke/TIA [b = -0.460, t(361.2) = -4.45, p < 0.001], but not WMH volume [b = 0.001, t(362.3) = -0.520, p = 0.603], predicted declines in cognition. When investigated in a combined model, a history of stroke/TIA remained a predictor of cognitive decline [b = -0.443, t(360.6) = -4.28, p < 0.001], whilst depressive symptoms did not [b = -0.012, t(359.7) = -0.96, p = 0.336].
This study is contrasted with previous prospective studies which indicate that depressive symptoms predict cognitive decline independently of vascular disease. Future research should focus on further exploring the vascular mechanisms underpinning the relationship between depressive symptoms and cognition.
有人提出，血管疾病是将抑郁和认知联系起来的机制，但前瞻性研究并不支持这一假设。本研究旨在使用特征明确的前瞻性队列研究来调查抑郁症状、认知和脑血管疾病之间的相互关系。
数据来自悉尼记忆与衰老研究（n = 462；平均年龄= 78.3 岁）的第 1 波（2005-2007 年）和第 2 波（2007-2009 年）。
在第 1 波时，抑郁症状与脑白质高信号（WMH）体积之间存在关联[b = 0.016，t（414）= 2.34，p = 0.020]。抑郁症状[b = -0.058，t（413）= -2.64，p = 0.009]和 WMH 体积[b = -0.011，t（413）= -3.77，p < 0.001]，但不是中风/短暂性脑缺血发作（TIA）[b = -0.328，t（413）= -1.90，p = 0.058]，与认知能力下降独立相关。前瞻性研究发现，脑血管病并不能预测抑郁症状的增加[中风/TIA：b = -0.349，t（374.7）= -0.76，p = 0.448；WMH 体积：b = 0.007，t（376.3）= 0.875，p = 0.382]。抑郁症状预测 WMH 严重程度的增加[b = 0.012，t（265.9）= -3.291，p = 0.001]，但不能预测中风/TIA 的发生（比值比= 0.995；CI 0.949-1.043；p = 0.820）。当在单独的模型中进行检查时，抑郁症状[b = -0.027，t（373.5）= -2.16，p = 0.032]和中风/TIA 的病史[b = -0.460，t（361.2）= -4.45，p < 0.001]，但不是 WMH 体积[b = 0.001，t（362.3）= -0.520，p = 0.603]，预测认知能力下降。当在综合模型中进行研究时，中风/TIA 的病史仍然是认知能力下降的预测因素[b = -0.443，t（360.6）= -4.28，p < 0.001]，而抑郁症状则不是[b = -0.012，t（359.7）= -0.96，p = 0.336]。
本研究与先前表明抑郁症状独立于血管疾病预测认知能力下降的前瞻性研究形成对比。未来的研究应重点进一步探讨抑郁症状和认知之间关系的血管机制。
