Alzheimer Centre Limburg, School for Mental Health and Neuroscience (MHeNS), Maastricht University, The Netherlands.
Geestelijk Gezondheidszorg Eindhoven en de Kempen (GGzE), The Netherlands.
J Alzheimers Dis. 2019;67(4):1319-1329. doi: 10.3233/JAD-180513.
Affective symptoms are considered a risk factor or prodromal symptom for dementia. Recent reviews indicate that depressive symptoms predict progression from mild cognitive impairment (MCI) to dementia, but results need to be further explored.
To investigate the effect of depressive symptoms on the development of dementia in people with MCI, and explore potential sources of between-study variability, including study setting by a systematic review and meta-analysis.
Databases were searched for prospective studies defining people with MCI at baseline, investigating dementia at follow-up and giving information about depressive symptoms. Two authors independently extracted data from the studies and rated the methodological quality. Meta-analyses were conducted using random-effect models to yield pooled risk ratios (RR). Meta-regression analyses tested differences between clinical and community-based studies and other sources of heterogeneity.
Thirty-five studies, representing 14,158 individuals with MCI, were included in the meta-analysis. Depressive symptoms in MCI predicted dementia in 15 community-based studies (RR = 1.69, 95% CI 1.49-1.93, I2 = 0.0%), but not in 20 clinical studies (RR = 1.02, 95% CI 0.92-1.14, I2 = 73.0%). Further investigation of this effect showed that the mean age of community-based studies was significantly higher than of clinical studies but neither this nor other study characteristics explained variability in study outcomes.
Depressive symptoms are associated with an increased risk of conversion from MCI to dementia in community-based studies. In contrast, evidence in clinical populations was insufficient with high heterogeneity.
情感症状被认为是痴呆的风险因素或前驱症状。最近的综述表明，抑郁症状可预测轻度认知障碍（MCI）向痴呆的进展，但结果仍需进一步探讨。
通过系统综述和荟萃分析，调查抑郁症状对 MCI 患者痴呆发展的影响，并探讨潜在的研究间变异性来源，包括研究场所。
检索数据库，纳入前瞻性研究，这些研究在基线时定义为 MCI 患者，在随访时调查痴呆，并提供抑郁症状信息。两名作者独立从研究中提取数据并对方法学质量进行评分。使用随机效应模型进行荟萃分析，得出汇总风险比（RR）。荟萃回归分析检验了临床和社区研究之间以及其他异质性来源的差异。
共有 35 项研究，涉及 14158 名 MCI 患者，纳入荟萃分析。MCI 中的抑郁症状预测了 15 项社区研究中的痴呆（RR=1.69，95%CI 1.49-1.93，I2=0.0%），但未预测 20 项临床研究中的痴呆（RR=1.02，95%CI 0.92-1.14，I2=73.0%）。进一步研究表明，社区研究的平均年龄明显高于临床研究，但无论是年龄还是其他研究特征，都无法解释研究结果的变异性。
抑郁症状与社区研究中 MCI 向痴呆的转化率增加相关。相比之下，临床人群的证据不足且存在高度异质性。
