Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel HaShomer, Israel.
Diabetes Care. 2021 Mar;44(3):655-662. doi: 10.2337/dc20-2031. Epub 2021 Jan 19.
Depression is highly frequent in older adults with type 2 diabetes and is associated with cognitive impairment, yet little is known about how various depression dimensions differentially affect cognition. We investigated longitudinal associations of specific depression dimensions with cognitive decline.
Participants ( = 1,002) were from the Israel Diabetes and Cognitive Decline study, were ≥65 years of age, had type 2 diabetes, and were not experiencing dementia at baseline. Participants underwent a comprehensive neuropsychological battery at baseline and every 18 months thereafter, including domains of episodic memory, attention/working memory, semantic categorization/language, and executive function, and -scores of each domain were averaged and further normalized to calculate global cognition. Depression items from the 15-item Geriatric Depression Scale were measured at each visit and subcategorized into five dimensions: dysphoric mood, withdrawal-apathy-vigor (entitled apathy), anxiety, hopelessness, and memory complaint. Random coefficients models examined the association of depression dimensions with baseline and longitudinal cognitive functioning, adjusting for sociodemographics and baseline characteristics, including cardiovascular risk factors, physical activity, and use of diabetes medications.
In the fully adjusted model at baseline, all dimensions of depression, except for anxiety, were associated with some aspect of cognition ( values from 0.01 to <0.001). Longitudinally, greater apathy scores were associated with faster decline in executive function ( = 0.004), a result that withstood adjustment for multiple comparisons. Associations of other depression dimensions with cognitive decline were not significant ( > 0.01).
Apathy was associated with a faster cognitive decline in executive function. These findings highlight the heterogeneity of depression as a clinical construct rather than as a single entity and point to apathy as a specific risk factor for cognitive decline among older adults with type 2 diabetes.
老年 2 型糖尿病患者中抑郁症的发病率很高，且与认知障碍相关，但对于不同的抑郁维度如何影响认知的了解甚少。本研究旨在探讨特定抑郁维度与认知衰退的纵向关联。
参与者（n=1002）来自以色列糖尿病与认知衰退研究，年龄≥65 岁，患有 2 型糖尿病，且在基线时无痴呆。参与者在基线时和此后每 18 个月进行一次全面的神经心理学测试，包括情景记忆、注意力/工作记忆、语义分类/语言和执行功能等领域，并对每个领域的 -评分进行平均，进一步标准化以计算总体认知。在每次就诊时都测量了来自 15 项老年抑郁量表的抑郁项目，并将其细分为五个维度：心境恶劣、退缩-冷漠-活力（称为冷漠）、焦虑、绝望和记忆抱怨。随机系数模型调整了社会人口统计学和基线特征（包括心血管危险因素、身体活动和糖尿病药物使用）后，研究了抑郁维度与基线和纵向认知功能的关系。
在完全调整的基线模型中，除焦虑外，所有抑郁维度（ 值从 0.01 到 <0.001）都与认知的某些方面有关。纵向来看，更大的冷漠分数与执行功能的更快下降相关（ = 0.004），这一结果在经过多次比较调整后仍然成立。其他抑郁维度与认知衰退的关联没有统计学意义（ > 0.01）。
冷漠与执行功能的认知衰退更快有关。这些发现强调了抑郁作为一种临床结构的异质性，而不是单一实体，并指出冷漠是老年 2 型糖尿病患者认知衰退的一个特定风险因素。
