Parkwood Institute (JP, ER, MM-O, and AMB), Schulich School of Medicine and Dentistry, Western University (AV, KSPL, and AMB); Lawson Health Research Institute (AV); Geriatric Mood Disorders Lab, Parkwood Institute (AV); Parkwood Institute-Mental Health (AMB); Lawson Health Research Institute Association (AMB); Departments of Medicine (Geriatric Medicine), and Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario (MM-O); and Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute (MM-O), London, Canada.
Parkwood Institute (JP, ER, MM-O, and AMB), Schulich School of Medicine and Dentistry, Western University (AV, KSPL, and AMB); Lawson Health Research Institute (AV); Geriatric Mood Disorders Lab, Parkwood Institute (AV); Parkwood Institute-Mental Health (AMB); Lawson Health Research Institute Association (AMB); Departments of Medicine (Geriatric Medicine), and Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario (MM-O); and Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute (MM-O), London, Canada.
Am J Geriatr Psychiatry. 2019 Dec;27(12):1375-1383. doi: 10.1016/j.jagp.2019.07.007. Epub 2019 Jul 23.
Prior literature has proposed that the coexistence of late-life depression, executive dysfunction and impaired gait speed may constitute a specific phenotype in older adults with a possible shared brain mechanism. All three conditions are independently associated with negative health outcomes including impaired function, risk of falling, and reduced quality of life. However, the existence, etiology, and implications of having all three conditions as a unitary triad remain unclear. This systematic review examined the literature to assess the consistency of this triad and to explore the possible role of frontal-subcortical circuitry in its etiology. English language literature that assessed mood, executive function, and gait speed using a validated tool in human participants over age 65 were included for this review. Following the PRISMA guidelines, 15 studies including 11,213 participants met criteria for inclusion in this study. The triad's existence was supported by 12 of the 15 studies (80%), including 4 longitudinal studies involving 368 participants. A prevalence of 17% was reported in one population study. The three included intervention studies provided mixed results regarding the benefit of pharmacologic and exercise interventions. Two studies assessed the association between presence of white matter hyperintensities and the triad, with one study finding a significant longitudinal relationship with periventricular white matter hyperintensities. Vascular risk factors were also commonly associated with this triad. Taken together, the relationship between this triad, the vascular depression hypothesis, and frontal-subcortical pathology is suggested. Further longitudinal research is needed to further clarify the etiology and clinical relevance of this concomitant prescence oflate-life depression, executive dysfunction and impaired gait speed.
先前的文献提出，老年期抑郁症、执行功能障碍和步态速度受损的共存可能构成老年患者的一种特定表型，其可能具有共同的大脑机制。这三种情况均与负面健康结果独立相关，包括功能受损、跌倒风险增加和生活质量降低。然而，作为一个单一三联体存在的条件、病因和意义尚不清楚。本系统评价检查了文献，以评估这三联体的一致性，并探讨额皮质下回路在其病因学中的可能作用。本综述纳入了使用经过验证的工具评估 65 岁以上人类参与者情绪、执行功能和步态速度的英文文献。根据 PRISMA 指南，有 15 项研究（包括 11213 名参与者）符合纳入本研究的标准。这三联体的存在得到了 15 项研究中的 12 项（80%）的支持，其中包括 4 项涉及 368 名参与者的纵向研究。一项人群研究报告了 17%的患病率。三项纳入的干预研究提供了关于药物和运动干预的益处的混合结果。两项研究评估了存在白质高信号与三联体之间的关系，其中一项研究发现与脑室周围白质高信号存在显著的纵向关系。血管危险因素也与该三联体密切相关。综上所述，该三联体、血管性抑郁假说和额皮质下病理学之间的关系被提出。需要进一步的纵向研究来进一步阐明这种老年期抑郁症、执行功能障碍和步态速度受损同时存在的病因和临床相关性。
