Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA.
Transl Psychiatry. 2021 Mar 2;11(1):147. doi: 10.1038/s41398-021-01269-y.
Late-life depression (LLD) is associated with an increased risk of developing dementia; however, it is not known whether individuals with a history of LLD exhibit a more rapid rate of cognitive decline. We aimed to determine whether those with LLD experienced faster cognitive decline compared with never-depressed control (NDC) participants from the community and whether stratification of LLD into early-onset depression (EOD) and late-onset depression (LOD) subtypes revealed differing rates and domain-specific expression of cognitive decline. We conducted a prospective, longitudinal study where 185 participants with LLD (remitted) and 114 NDC were followed for 5 years on average. EOD was defined as having first lifetime depressive episode at <60years and LOD at ≥60years. Every year, participants underwent comprehensive neuropsychological assessment. Composite scores for each cognitive domain were calculated through averaging standardized scores across tests. LLD compared to NDC demonstrated significant baseline impairment but did not decline more rapidly. EOD were significantly impaired in attention/processing speed and global cognitive function at baseline but did not experience more rapid decline as compared to NDC. Those with LOD compared to both NDC and EOD performed worse in all domains at baseline and experienced more rapid decline in verbal skills and delayed memory ability. Our findings suggest that baseline impairment may lower the threshold for those with LLD to develop dementia. EOD and LOD may represent distinct phenotypes of cognitive impairment with differing neural substrates. LOD may represent a distinct phenotype with a more rapid decline in verbal skills and delayed memory.
老年期抑郁症（LLD）与痴呆风险增加相关；然而，尚不清楚是否有 LLD 病史的个体表现出更快的认知衰退速度。我们旨在确定与从未抑郁的对照组（NDC）参与者相比，患有 LLD 的个体是否经历更快的认知衰退，以及将 LLD 分层为早发性抑郁（EOD）和晚发性抑郁（LOD）亚型是否揭示了认知衰退的不同速度和特定领域的表现。我们进行了一项前瞻性、纵向研究，其中 185 名患有 LLD（缓解）的参与者和 114 名 NDC 参与者平均随访 5 年。EOD 定义为首次在 60 岁之前发生终生抑郁发作，LOD 定义为在 60 岁或之后发生。每年，参与者都接受全面的神经心理评估。通过在测试中平均标准化分数来计算每个认知域的综合分数。与 NDC 相比，LLD 在基线时表现出明显的损伤，但下降速度没有更快。EOD 在基线时在注意力/处理速度和整体认知功能方面受损显著，但与 NDC 相比，其下降速度没有更快。与 NDC 和 EOD 相比，LOD 在基线时在所有领域的表现都更差，并且在言语技能和延迟记忆能力方面的下降速度更快。我们的研究结果表明，基线损伤可能会降低患有 LLD 的个体发展为痴呆的阈值。EOD 和 LOD 可能代表具有不同神经基础的认知障碍的不同表型。LOD 可能代表一种具有更快的言语技能和延迟记忆下降的独特表型。
