Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Alzheimer's Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai 200030, China; Department of Neurology and Psychology, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen 518000, China.
Shanghai Xuhui District Mental Health Center, Shanghai 200232, China.
Asian J Psychiatr. 2024 May;95:104007. doi: 10.1016/j.ajp.2024.104007. Epub 2024 Mar 18.
To examine different trajectories of cognitive changes in elderly adults and explore the mediating role of depressive symptoms.
A 7-year, community-based, prospective cohort study.
The downtown neighborhood of Shanghai, China.
A cohort of 394 older adults, with an average age of 71.8 years, was recruited in 2015 and has been reassessed every two years until 2021.
Latent Class Growth Analysis was used to model aging trajectories and Linear Mixed-Effect Models for Repeated Measures were used to estimate the least squares mean changes of cognition between subjects with depression (DEP) and without (DEP) across all visits.
Three cognitive trajectories were identified: the "successful aging" (SA) trajectory had the best and most consistent performance (n=229, 55.9%); the "normal aging" (NA) trajectory showed lower but stable cognition (n=141, 37.3%); while the "cognitive decline" (CD) trajectory displayed poor and declining cognition (n=24, 6.8%). Depressive symptoms were found to be influential across all trajectories. In the CD trajectory, the MoCA scores of the DEP group increased in within-group comparisons and were significantly higher than those of the DEP group at visits 1 and 3 in between-group comparisons. A similar trend was observed in the NA trajectory, though it did not reach statistical significance.
Our research suggests that mild and decreasing depressive symptoms can be a reversible factor that might slow down the irreversible cognitive decline in the elderly. Therefore, we suggest that even mild depressive symptoms in the elderly should be monitored and detected.
探讨老年人认知变化的不同轨迹，并探索抑郁症状的中介作用。
一项为期 7 年的基于社区的前瞻性队列研究。
中国上海市区。
招募了一组平均年龄为 71.8 岁的 394 名老年人，于 2015 年进行了评估，并在 2021 年之前每两年重新评估一次。
采用潜在类别增长分析来构建老化轨迹模型，采用重复测量线性混合效应模型来估计在所有访问中患有（DEP）和不患有（DEP）抑郁的个体之间认知的最小二乘均值变化。
确定了三种认知轨迹：“成功老化”（SA）轨迹表现最佳且最一致（n=229，55.9%）；“正常老化”（NA）轨迹表现较低但稳定的认知（n=141，37.3%）；而“认知下降”（CD）轨迹表现出较差且下降的认知（n=24，6.8%）。抑郁症状在所有轨迹中均有影响。在 CD 轨迹中，DEP 组的 MoCA 评分在组内比较中增加，且在组间比较中，在第 1 次和第 3 次访问时均明显高于 DEP 组。在 NA 轨迹中也观察到类似的趋势，但未达到统计学意义。
我们的研究表明，轻度和逐渐减轻的抑郁症状可能是一种可逆转的因素，可减缓老年人不可逆转的认知衰退。因此，我们建议即使是老年人的轻度抑郁症状也应进行监测和检测。
