针对老年抑郁症患者轻度认知障碍的预防：一项针对潜在可改变风险因素的观察性研究。
Toward Prevention of Mild Cognitive Impairment in Older Adults With Depression: An Observational Study of Potentially Modifiable Risk Factors.
机构信息
Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario M4N 3M5.
Division of Geriatric Psychiatry, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada.
出版信息
J Clin Psychiatry. 2018 Nov 27;80(1):18m12331. doi: 10.4088/JCP.18m12331.
OBJECTIVE
Late-life depression has been associated with increased risk of mild cognitive impairment (MCI) and dementia. Predictors of increased risk are incompletely understood. Identification of potentially modifiable risk factors could facilitate prevention of MCI and dementia. This study aimed to determine which clinical characteristics are associated with increased risk of MCI among older adults with depression and normal cognition at baseline.
METHODS
Data from the National Alzheimer's Coordinating Center dataset were used. Study participants who attended a participating Alzheimer's Disease Center from September 2005 through September 2017 with normal cognition and a history of clinically defined depression (broadly based on DSM criteria) were followed until first diagnosis of MCI (or dementia when MCI was not diagnosed).
RESULTS
A total of 2,655 study participants were followed for a median duration of 41.8 months. Of these, 586 (22.1%) developed either MCI (n = 509, 19.2%) or dementia (n = 77, 2.9%). In survival analyses, cognitive decline was associated with age, sex, education, baseline cognition, and several potentially modifiable risk factors including vascular risk factors, hearing impairment, vitamin B₁₂ deficiency, active depression within the last 2 years, and increased severity of depression. In an adjusted survival analysis, the only variables that remained significantly associated with development of MCI or dementia were female sex (HR = 0.72; 95% CI, 0.59-0.88), higher education (HR = 0.96; 95% CI, 0.93-0.99), and higher baseline cognition (HR = 0.87; 95% CI, 0.82-0.93), which were associated with reduced risk, and older age (HR = 1.07; 95% CI, 1.05-1.08), active depression within the last 2 years (HR = 1.41; 95% CI, 1.15-1.74), and increased severity of depression (HR = 1.05; 95% CI, 1.02-1.09), which were associated with increased risk.
CONCLUSIONS
Development of MCI is associated with several potentially modifiable risk factors in older adults with depression. Future studies should determine whether active management of risk factors could reduce incidence of MCI in this vulnerable population.
目的
晚年抑郁症与轻度认知障碍（MCI）和痴呆的风险增加有关。风险增加的预测因素尚不完全清楚。确定潜在的可改变的危险因素可以促进 MCI 和痴呆的预防。本研究旨在确定哪些临床特征与基线时认知正常但有临床定义的抑郁症病史的老年抑郁症患者发生 MCI 的风险增加相关。
方法
使用国家阿尔茨海默病协调中心数据集的数据。从 2005 年 9 月至 2017 年 9 月参加参与阿尔茨海默病中心的研究参与者，如果认知正常且有临床定义的抑郁症病史（广泛基于 DSM 标准），则在首次诊断为 MCI（或 MCI 未诊断时为痴呆）之前进行随访。
结果
共有 2655 名研究参与者的中位随访时间为 41.8 个月。其中，586 名（22.1%）发生 MCI（n=509，19.2%）或痴呆（n=77，2.9%）。在生存分析中，认知能力下降与年龄、性别、教育程度、基线认知以及几个潜在的可改变的危险因素相关，包括血管危险因素、听力障碍、维生素 B₁₂ 缺乏、最近 2 年内的活动性抑郁以及抑郁严重程度增加。在调整后的生存分析中，唯一与 MCI 或痴呆发展显著相关的变量是女性（HR=0.72；95%CI，0.59-0.88）、较高的教育程度（HR=0.96；95%CI，0.93-0.99）和较高的基线认知（HR=0.87；95%CI，0.82-0.93），这些因素与风险降低相关，而年龄较大（HR=1.07；95%CI，1.05-1.08）、最近 2 年内的活动性抑郁（HR=1.41；95%CI，1.15-1.74）和抑郁严重程度增加（HR=1.05；95%CI，1.02-1.09）与风险增加相关。
结论
在患有抑郁症的老年人中，MCI 的发展与几个潜在的可改变的危险因素有关。未来的研究应确定积极管理这些危险因素是否可以降低这一脆弱人群 MCI 的发病率。
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