Department Old Age Psychiatry, GGZ Drenthe Mental Health Institute, Assen, The Netherlands.
University Center of Psychiatry and Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, The Netherlands.
J Gerontol A Biol Sci Med Sci. 2021 Jan 1;76(1):141-150. doi: 10.1093/gerona/glaa110.
With increasing age, symptoms of depression may increasingly overlap with age-related physical frailty and cognitive decline. We aim to identify late-life-related subtypes of depression based on measures of depressive symptom dimensions, cognitive performance, and physical frailty.
A clinical cohort study of 375 depressed older patients with a DSM-IV depressive disorder (acronym NESDO). A latent profile analysis was applied on the three subscales of the Inventory of Depressive Symptomatology, as well as performance in five cognitive domains and two proxies for physical frailty. For each class, we investigated remission, dropout, and mortality at 2-year follow-up as well as change over time of depressive symptom severity, cognitive performance, and physical frailty.
A latent profile analysis model with five classes best described the data, yielding two subgroups suffering from pure depression ("mild" and "severe" depression, 55% of all patients) and three subgroups characterized by a specific profile of cognitive and physical frailty features, labeled as "amnestic depression," "frail-depressed, physically dominated," and "frail-depressed, cognitively dominated." The prospective analyses showed that patients in the subgroup of "mild depression" and "amnestic depression" had the highest remission rates, whereas patients in both frail-depressed subgroups had the highest mortality rates.
Late-life depression can be subtyped by specific combinations of age-related clinical features, which seems to have prospective relevance. Subtyping according to the cognitive profile and physical frailty may be relevant for studies examining underlying disease processes as well as to stratify treatment studies on the effectiveness of antidepressants, psychotherapy, and augmentation with geriatric rehabilitation.
随着年龄的增长，抑郁症状可能会越来越与与年龄相关的身体虚弱和认知能力下降相重叠。我们旨在根据抑郁症状维度、认知表现和身体虚弱的测量结果，确定与晚年相关的抑郁亚型。
这是一项针对 375 名患有 DSM-IV 抑郁障碍的老年抑郁患者（简称 NESDO）的临床队列研究。对抑郁症状量表的三个分量表，以及五个认知领域的表现和身体虚弱的两个代表指标进行潜在剖面分析。对于每个类别，我们调查了两年随访时的缓解、辍学和死亡率，以及抑郁症状严重程度、认知表现和身体虚弱随时间的变化。
具有五个类别的潜在剖面分析模型最能描述数据，产生了两个亚组，分别患有单纯抑郁（“轻度”和“重度”抑郁，占所有患者的 55%）和三个亚组，其特征是特定的认知和身体虚弱特征的特定特征，分别标记为“遗忘型抑郁”、“虚弱-抑郁，身体为主导”和“虚弱-抑郁，认知为主导”。前瞻性分析表明，“轻度抑郁”和“遗忘型抑郁”亚组的患者缓解率最高，而两个虚弱抑郁亚组的患者死亡率最高。
晚年抑郁症可以通过与年龄相关的特定临床特征的组合进行亚型分类，这似乎具有前瞻性意义。根据认知特征和身体虚弱进行分类可能与研究潜在的疾病过程有关，也可能有助于对抗抑郁药、心理治疗和老年康复增效的治疗研究进行分层。
