Taylor Warren D, Ajilore Olusola, Karim Helmet T, Butters Meryl A, Krafty Robert, Boyd Brian D, Banihashemi Layla, Szymkowicz Sarah M, Ryan Claire, Hassenstab Jason, Landman Bennett A, Andreescu Carmen
Center for Cognitive Medicine, Department of Psychiatry and Behavioral Science, Vanderbilt University Medical Center, Nashville, TN.
Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Health System, Nashville, TN.
J Mood Anxiety Disord. 2024 Mar;5. doi: 10.1016/j.xjmad.2023.100038. Epub 2023 Nov 4.
Late-life depression is characterized by disability, cognitive impairment and decline, and a high risk of recurrence following remission. Aside from past psychiatric history, prognostic neurobiological and clinical factors influencing recurrence risk are unclear. Moreover, it is unclear if cognitive impairment predisposes to recurrence, or whether recurrent episodes may accelerate brain aging and cognitive decline. The purpose of the REMBRANDT study (Recurrence markers, cognitive burden, and neurobiological homeostasis in late-life depression) is to better elucidate these relationships and identify phenotypic, cognitive, environmental, and neurobiological factors contributing to and predictive of depression recurrence.
Across three sites, REMBRANDT will enroll 300 depressed elders who will receive antidepressant treatment. The goal is to enroll 210 remitted depressed participants and 75 participants with no mental health history into a two-year longitudinal phase focusing on depression recurrence. Participants are evaluated every 2 months with deeper assessments occurring every 8 months, including structural and functional neuroimaging, environmental stress assessments, deep symptom phenotyping, and two weeks of 'burst' ecological momentary assessments to elucidate variability in symptoms and cognitive performance. A broad neuropsychological test battery is completed at the beginning and end of the longitudinal study.
REMBRANDT will improve our understanding of how alterations in neural circuits and cognition that persist during remission contribute to depression recurrence vulnerability. It will also elucidate how these processes may contribute to cognitive impairment and decline. This project will obtain deep phenotypic data that will help identify vulnerability and resilience factors that can help stratify individual clinical risk.
老年期抑郁症的特征包括残疾、认知障碍与衰退，以及缓解后复发风险高。除了既往精神病史外，影响复发风险的预后神经生物学和临床因素尚不清楚。此外，尚不清楚认知障碍是否易导致复发，或者复发发作是否会加速脑老化和认知衰退。REMBRANDT研究（老年期抑郁症的复发标志物、认知负担和神经生物学稳态）的目的是更好地阐明这些关系，并确定导致抑郁症复发并可预测复发的表型、认知、环境和神经生物学因素。
在三个地点，REMBRANDT将招募300名患有抑郁症的老年人，他们将接受抗抑郁治疗。目标是招募210名已缓解的抑郁症参与者和75名无精神病史的参与者进入为期两年的纵向研究阶段，重点关注抑郁症复发。参与者每2个月接受一次评估，每8个月进行更深入的评估，包括结构和功能神经影像学、环境压力评估、深度症状表型分析，以及为期两周的“突发”生态瞬时评估，以阐明症状和认知表现的变异性。在纵向研究开始和结束时完成一套广泛 的神经心理学测试。
REMBRANDT将增进我们对缓解期持续存在的神经回路和认知改变如何导致抑郁症复发易感性的理解。它还将阐明这些过程如何导致认知障碍和衰退。该项目将获得深度表型数据，有助于识别可用于对个体临床风险进行分层的脆弱性和恢复力因素。
