老年人中抑郁与认知障碍合并存在对功能残疾和死亡率的影响：一项基于2011 - 2014年美国国家健康与营养检查调查（NHANES）的人群研究
The combined associations of depression and cognitive impairment with functional disability and mortality in older adults: a population-based study from the NHANES 2011-2014.
作者信息
Han Shuang, Gao Yue, Gan Da
机构信息
Zhejiang Key Laboratory of Traditional Chinese Medicine for the Prevention and Treatment of Senile Chronic Diseases, Department of Geriatrics, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Chronic Disease Research Institute, The Children's Hospital, and National Clinical Research Center for Child Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
出版信息
Front Aging Neurosci. 2023 May 4;15:1121190. doi: 10.3389/fnagi.2023.1121190. eCollection 2023.
OBJECTIVE
The present study aimed to explore the combined associations of depression and cognitive impairment with functional disability and mortality, and whether the joint effects of depression and cognitive impairment on mortality were influenced by functional disability.
METHODS
A total of 2,345 participants aged 60 and above from the 2011-2014 cycle of the National Health and Nutrition Examination Survey (NHANES) were included in the analyses. Questionnaires were used to evaluated depression, global cognitive function and functional disability (including disability in activities of daily living (ADLs), instrumental activities of daily living (IADLs), leisure and social activities (LSA), lower extremity mobility (LEM), and general physical activity (GPA)). Mortality status was ascertained up to December 31, 2019. Multivariable logistic regression was performed to investigate the associations of depression and low global cognition with functional disability. Cox proportional hazards regression models were conducted to evaluate the effect of depression and low global cognition on mortality.
RESULTS
Interactions between depression and low global cognition were observed when exploring associations of depression and low global cognition with IADLs disability, LEM disability, and cardiovascular mortality. Compared with normal participants, participants with both depression and low global cognition had the highest odds ratios of disability in ADLs, IADLs, LSA, LEM, and GPA. Besides, participants with both depression and low global cognition also had the highest hazard ratios of all-cause mortality and cardiovascular mortality, and these associations remained after adjusting for disability in ADLs, IADLs, LSA, LEM, and GPA.
CONCLUSION
Older adults with both depression and low global cognition were more likely to have functional disability, and had the highest risk of all-cause mortality and cardiovascular mortality.
目的
本研究旨在探讨抑郁与认知障碍与功能残疾和死亡率的联合关联，以及抑郁和认知障碍对死亡率的联合影响是否受功能残疾的影响。
方法
分析纳入了2011 - 2014年国家健康与营养检查调查（NHANES）中2345名60岁及以上的参与者。采用问卷评估抑郁、整体认知功能和功能残疾（包括日常生活活动（ADL）残疾、工具性日常生活活动（IADL）残疾、休闲和社交活动（LSA）、下肢活动能力（LEM）以及一般身体活动（GPA））。截至2019年12月31日确定死亡率状况。进行多变量逻辑回归以研究抑郁和低整体认知与功能残疾的关联。采用Cox比例风险回归模型评估抑郁和低整体认知对死亡率的影响。
结果
在探讨抑郁和低整体认知与IADL残疾、LEM残疾和心血管死亡率的关联时，观察到抑郁与低整体认知之间存在相互作用。与正常参与者相比，同时患有抑郁和低整体认知的参与者在ADL、IADL、LSA、LEM和GPA方面残疾的比值比最高。此外，同时患有抑郁和低整体认知的参与者全因死亡率和心血管死亡率的风险比也最高，在对ADL、IADL、LSA、LEM和GPA残疾进行调整后，这些关联仍然存在。
结论
同时患有抑郁和低整体认知的老年人更有可能出现功能残疾，并且全因死亡率和心血管死亡率风险最高。
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