Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA.
J Psychiatr Res. 2019 Apr;111:30-35. doi: 10.1016/j.jpsychires.2019.01.012. Epub 2019 Jan 11.
Discrepancies exist on the associations of late-life depression with cognition, and synergistic effect of depression and diabetes on cognition among older adults was suggested in literature. We aimed to examine the associations of late-life depression with cognitive function in a representative sample of older adults in the U.S., and to examine the associations among individuals with diabetes. A total of 3101 adults aged 60 and above of the 2011-2014 National Health and Nutrition Examination Survey who completed measurements of depressive symptoms and diabetes were included in cross-sectional analyses. The 9-item Patient Health Questionnaire (PHQ-9) was used to measure depressive symptoms (including overall, somatic and cognitive). Clinically relevant depression (CRD) and clinically significant depression (CSD) were defined by cutoffs of PHQ-9. Domain-specific cognitive function was examined using Delayed Word Recall Test, Digit Symbol Substitution Test, and Animal Fluency Test for memory, executive function/processing speed, and language, respectively. Z scores were created for overall cognition and specific domains. Multivariable linear regression models were applied to examine the association of depressive symptoms and scale-defined depression with cognition z scores. The overall, somatic and cognitive depressive symptoms were associated with lower cognitive function among older adults. Both CRD (β = -0.20, 95% CI: -0.28, -0.12) and CSD (β = -0.56, 95% CI: -0.75, -0.37) were associated with lower cognition. A synergistic relationship was found between depression and diabetes on lower cognition. These results suggested that cognition among older adults may be modified by late-life depression, and older adults with both depression and diabetes may be particularly impacted on cognition.
老年人的抑郁与认知之间的关联存在差异，文献中也提示了抑郁和糖尿病对老年人认知的协同作用。我们旨在检验美国代表性老年人群体中晚年抑郁与认知功能的关联，并检验患有糖尿病的个体之间的关联。共纳入横断面分析了 2011-2014 年全国健康与营养调查中 3101 名年龄在 60 岁及以上、完成抑郁症状和糖尿病测量的成年人。使用 9 项患者健康问卷 (PHQ-9) 测量抑郁症状（包括总体、躯体和认知）。采用 PHQ-9 的截点定义临床相关抑郁 (CRD) 和临床显著抑郁 (CSD)。使用延迟单词回忆测试、数字符号替代测试和动物流畅性测试分别评估记忆、执行功能/处理速度和语言的特定领域认知功能。为总体认知和特定领域创建了 Z 分数。多变量线性回归模型用于检验抑郁症状和量表定义的抑郁与认知 z 分数的关联。总体、躯体和认知抑郁症状与老年人认知功能降低有关。CRD (β= -0.20, 95% CI: -0.28, -0.12) 和 CSD (β= -0.56, 95% CI: -0.75, -0.37) 均与认知降低有关。在认知降低方面，抑郁和糖尿病之间存在协同关系。这些结果表明，晚年抑郁可能会改变老年人的认知，并且同时患有抑郁和糖尿病的老年人可能在认知方面受到特别影响。
