Department of Psychiatry, School of Medicine, University of Pittsburgh Medical Center Western Psychiatric Hospital, Pittsburgh, Pennsylvania.
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
JAMA Psychiatry. 2022 Oct 1;79(10):1023-1031. doi: 10.1001/jamapsychiatry.2022.2573.
Evidence regarding the nature and prevalence of 24-hour activity pattern phenotypes in older adults, especially those related to depression symptoms and cognition, is needed to guide the development of targeted mechanism research and behavioral interventions.
To identify subgroups of older adults with similar 24-hour activity rhythm characteristics and characterize associated depression symptoms and cognitive performance.
DESIGN, SETTING, AND PARTICIPANTS: From January to March 2022, a cross-sectional analysis of the 2011-2014 National Health and Nutrition Examination and Survey (NHANES) accelerometer study was conducted. The NHANES used a multistage probability sample that was designed to be representative of noninstitutionalized adults in the US. The main analysis included participants 65 years or older who had accelerometer and depression measures weighted to represent approximately 32 million older adults.
Latent profile analysis identified subgroups with similar 24-hour activity pattern characteristics as measured using extended-cosine and nonparametric methods.
Covariate-adjusted sample-weighted regressions assessed associations of subgroup membership with (1) depression symptoms defined as 9-Item Patient Health Questionnaire (PHQ-9) scores of 10 or greater (PHQ-9) and (2) having at least psychometric mild cognitive impairment (p-MCI) defined as scoring less than 1 SD below the mean on a composite cognitive performance score.
The actual clustering sample size was 1800 (weighted: mean [SD] age, 72.9 [7.3] years; 57% female participants). Clustering identified 4 subgroups: (1) 677 earlier rising/robust (37.6%), (2) 587 shorter active period/less modelable (32.6%), (3) 177 shorter active period/very weak (9.8%), and (4) 359 later settling/very weak (20.0%). The prevalence of a PHQ-9 score of 10 or greater differed significantly across groups (cluster 1, 3.5%; cluster 2, 4.7%; cluster 3, 7.5%; cluster 4, 9.0%; χ2 P = .004). The prevalence of having at least p-MCI differed significantly across groups (cluster 1, 7.2%; cluster 2, 12.0%; cluster 3, 21.0%; cluster 4, 18.0%; χ2 P < .001). Five of 9 depression symptoms differed significantly across subgroups.
In this cross-sectional study, findings indicate that approximately 1 in 5 older adults in the US may be classified in a subgroup with weak activity patterns and later settling, and approximately 1 in 10 may be classified in a subgroup with weak patterns and shorter active duration. Future research is needed to investigate the biologic processes related to these behavioral phenotypes, including why earlier and robust activity patterns appear protective, and whether modifying disrupted patterns improves outcomes.
需要有证据表明老年人（尤其是与抑郁症状和认知相关的） 24 小时活动模式表型的性质和普遍性，以指导针对特定机制的研究和行为干预措施的发展。
确定具有相似 24 小时活动节律特征的老年人亚组，并描述其与抑郁症状和认知表现的关系。
设计、地点和参与者：2022 年 1 月至 3 月期间，对 2011-2014 年全国健康和营养调查（NHANES）加速度计研究进行了横断面分析。NHANES 采用多阶段概率抽样，旨在代表美国的非机构化成年人。主要分析包括年龄在 65 岁或以上、使用加速度计和抑郁测量值且经过加权以代表约 3200 万老年人的参与者。
潜在特征分析确定了使用扩展余弦和非参数方法测量的具有相似 24 小时活动模式特征的亚组。
调整协变量的样本加权回归评估了亚组归属与以下因素之间的关联：（1）抑郁症状定义为 9 项患者健康问卷（PHQ-9）评分≥10 分（PHQ-9）；（2）至少存在轻度认知障碍（p-MCI），定义为复合认知表现评分低于平均值 1 个标准差。
实际聚类样本量为 1800 人（加权：平均[SD]年龄，72.9[7.3]岁；57%为女性参与者）。聚类确定了 4 个亚组：（1）677 名早起/活跃（37.6%）；（2）587 名活动时间较短/可建模性较差（32.6%）；（3）177 名活动时间较短/非常微弱（9.8%）；（4）359 名晚起/非常微弱（20.0%）。不同组之间 PHQ-9 评分≥10 的发生率存在显著差异（簇 1：3.5%；簇 2：4.7%；簇 3：7.5%；簇 4：9.0%；χ2 P = .004）。不同组之间至少存在轻度认知障碍的发生率存在显著差异（簇 1：7.2%；簇 2：12.0%；簇 3：21.0%；簇 4：18.0%；χ2 P < .001）。在 9 项抑郁症状中有 5 项在亚组之间存在显著差异。
在这项横断面研究中，研究结果表明，美国约有 1/5 的老年人可能被归为活动模式较弱且晚起的亚组，约有 1/10 的老年人可能被归为活动模式较弱且活动时间较短的亚组。未来需要进一步研究与这些行为表型相关的生物学过程，包括为什么早期和活跃的活动模式具有保护作用，以及是否可以通过改变异常模式来改善结果。
