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抑郁症状-在非遗忘型和遗忘型轻度认知障碍主观认知下降患者中,不是五年死亡率的预测因素。

Depressive symptoms-Not a predictor for five-year mortality in patients with subjective cognitive decline, non-amnestic and amnestic mild cognitive impairment.

机构信息

Department of Neurology, Medical University of Vienna, Währinger Gürtel 18- 20, 1090, Vienna, Austria.

出版信息

Neuropsychiatr. 2024 Sep;38(3):135-144. doi: 10.1007/s40211-024-00495-2. Epub 2024 May 22.

Abstract

The main aim of the present study is to evaluate the influence of depressive symptoms on mortality in patients with SCD (subjective cognitive decline), naMCI (non-amnestic mild cognitive impairment), and aMCI (amnestic mild cognitive impairment). Additional factors (age, sex, years of school attendance, and neuropsychological performance) were considered to determine the impact on survival probability. A monocentric retrospective data analysis based on adjusted patient protocols (n = 1221) from the observation period 1998-2021, using the Cox Proportional Hazards model, assessed whether depressivity had an explanatory value for survival, considering SCD as the reference level in relation to naMCI and aMCI. Covariates were included blockwise. Cox regression revealed that depressiveness (Beck Depression Inventory, Geriatric Depression Scale) did not make a significant contribution as a risk factor for mortality in all five model blocks, BDI-II with HR 0.997 [0.978; 1.02] and GDS-15 with HR 1.03 [0.98; 1.08]. Increasing age with HR 1.09 [1.07; 1.11] and male sex with HR (inverted) 1.53 [1.17; 2.00] appeared as risk factors for increased mortality across all five model blocks. aMCI (vs. SCD) with HR 1.91 [1.33; 2.76] showed a significant explanatory value only up to the fourth model block. By adding the six dimensions of the Neuropsychological Test Battery Vienna in the fifth model block, the domains attention and perceptual speed with HR 1.34 [1.18; 1.53], and executive functions with HR 1.24 [1.11; 1.39], showed substantial explanatory values for survival. Accordingly, no tendency can be attributed to depressiveness as a risk factor on the probability of survival, whereas the influence of certain cognitive dimensions, especially attention and perceptual speed, and executive functions, can be seen as protective for survival.

摘要

本研究的主要目的是评估抑郁症状对 SCD(主观认知下降)、naMCI(非遗忘性轻度认知障碍)和 aMCI(遗忘性轻度认知障碍)患者死亡率的影响。还考虑了其他因素(年龄、性别、受教育年限和神经心理学表现),以确定其对生存概率的影响。基于 1998 年至 2021 年观察期内调整后的患者方案(n=1221)进行的单中心回顾性数据分析,使用 Cox 比例风险模型,评估了抑郁状态是否对生存具有解释价值,以 SCD 作为参考水平,与 naMCI 和 aMCI 进行比较。采用逐步回归法纳入协变量。Cox 回归显示,在所有五个模型块中,抑郁状态(贝克抑郁量表、老年抑郁量表)均未作为死亡率的危险因素做出显著贡献,BDI-II 的 HR 为 0.997 [0.978;1.02],GDS-15 的 HR 为 1.03 [0.98;1.08]。年龄增长 HR 为 1.09 [1.07;1.11]和男性 HR(反转)为 1.53 [1.17;2.00],这些因素在所有五个模型块中均表现为增加死亡率的危险因素。aMCI(与 SCD 相比)的 HR 为 1.91 [1.33;2.76],仅在第四个模型块中具有显著的解释价值。在第五个模型块中加入维也纳神经心理学测试电池的六个维度后,注意力和知觉速度的 HR 为 1.34 [1.18;1.53],执行功能的 HR 为 1.24 [1.11;1.39],对生存具有显著的解释价值。因此,不能将抑郁状态视为影响生存概率的危险因素,而某些认知维度,特别是注意力和知觉速度以及执行功能,对生存具有保护作用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eef4/11379728/f0d457eb83be/40211_2024_495_Fig1_HTML.jpg

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