Stahl Sarah T, Altmann Helene M, Dew Mary Amanda, Albert Steven M, Butters Meryl, Gildengers Ariel, Reynolds Charles F, Karp Jordan F
Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
J Am Geriatr Soc. 2021 May;69(5):1265-1271. doi: 10.1111/jgs.17024. Epub 2021 Jan 2.
BACKGROUND/OBJECTIVES: Gait speed and psychomotor speed slow with age and may predict neuropsychiatric disease such as depression and anxiety. We explored the relative predictive values of gait speed, psychomotor slowing, and a composite index of these two measures on time to new episode depression or anxiety in older adults at risk for these common psychiatric conditions.
Randomized controlled prevention trial with 15-month follow-up.
University-based late-life mental health research clinic.
Two hundred thirteen individuals, age 60+ years, with subsyndromal symptoms of depression or anxiety and one of the following risk factors for these common conditions: mild cognitive impairment, knee osteoarthritis, or disabilities requiring home-based care.
Participants in each of the risk factor groups were randomized to a depression-specific preventive intervention or usual care.
Gait speed: 4-m walk test from the Short Physical Performance Battery. Psychomotor speed: Coding task of the Repeatable Battery for the Assessment of Neuropsychological Status. We created a composite index of slowing by determining whether participants exceeded established cut-offs for slow performance in both gait speed (≤0.8 m/s) and psychomotor speed (<7 on the coding task). Time to new onset syndromal depression/anxiety was measured using research diagnostic criteria.
Fifty-four participants developed syndromal depression/anxiety (19.5%) over the course of 15 months. Participants with slowing in both areas were over twice as likely to experience new onset depression/anxiety (hazard ratio (HR) = 2.11; 95% confidence interval (CI) = 1.02-4.40, P = .046) compared to participants with no slowing in either area. Slowed gait (HR = 1.88; 95% CI = 0.992-3.55; P = .052) or slowed psychomotor speed (HR = 0.60; 95% CI = 0.14-2.58; P = .488) alone did not increase risk for depression/anxiety.
Evaluating both gait and psychomotor speed in older adults with medical comorbidities and sub-syndromal depression may predict incident mental illness and inform prevention planning. Future research is needed to validate our observations and explore shared neurobiological mechanisms that explain this elevated risk.
背景/目的：步态速度和精神运动速度会随着年龄增长而减慢，并且可能预示着神经精神疾病，如抑郁症和焦虑症。我们探讨了步态速度、精神运动迟缓以及这两种测量方法的综合指数，对于有这些常见精神疾病风险的老年人新发抑郁症或焦虑症发病时间的相对预测价值。
一项为期15个月随访的随机对照预防试验。
大学附属的老年心理健康研究诊所。
213名年龄在60岁及以上的个体，有抑郁症或焦虑症的亚综合征症状，并且存在以下这些常见疾病的风险因素之一：轻度认知障碍、膝关节骨关节炎或需要居家护理的残疾。
每个风险因素组的参与者被随机分配到特定于抑郁症的预防性干预措施或常规护理。
步态速度：采用简短体能状况量表中的4米步行测试。精神运动速度：使用可重复神经心理状态评估量表中的编码任务。我们通过确定参与者在步态速度（≤0.8米/秒）和精神运动速度（编码任务得分<7）方面是否超过既定的缓慢表现临界值，创建了一个综合的迟缓指数。新发综合征性抑郁症/焦虑症的发病时间采用研究诊断标准进行测量。
在15个月的过程中，54名参与者出现了综合征性抑郁症/焦虑症（19.5%）。与在这两个方面均未出现迟缓的参与者相比，在这两个方面都出现迟缓的参与者发生新发抑郁症/焦虑症的可能性高出两倍多（风险比（HR）=2.11；95%置信区间（CI）=1.02 - 4.40，P = 0.046）。单独的步态迟缓（HR = 1.88；95% CI = 0.992 - 3.55；P = 0.052）或精神运动速度迟缓（HR = 0.60；95% CI = 0.14 - 2.58；P = 0.488）并不会增加患抑郁症/焦虑症的风险。
对患有内科合并症和亚综合征性抑郁症的老年人同时评估步态和精神运动速度，可能预测新发精神疾病，并为预防计划提供参考。需要进一步的研究来验证我们的观察结果，并探索解释这种风险升高的共同神经生物学机制。
