School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China.
China Center for Health Development Studies, Peking University, Beijing, China.
J Gerontol B Psychol Sci Soc Sci. 2024 Jul 1;79(7). doi: 10.1093/geronb/gbae084.
This study aims to investigate the association and dose-response relationship between depression, dementia, and all-cause mortality based on a national cohort study of older adults in Japan.
We conducted a longitudinal study of 44,546 participants ≥65 years from 2010-2019 Japanese Gerontological Evaluation Study. The Geriatric Depression Scale-15 was used to assess depressive symptoms and the long-term care insurance was used to assess dementia. Fine-Gray models and Cox proportional hazard models were used to explore the effect of depression severity on the incidence of dementia and all-cause mortality, respectively. Causal mediation analysis were used to explore the extent of association between dementia-mediated depression and all-cause mortality.
We found that both minor and major depressive symptoms were associated with the increased cumulative incidence of dementia and all-cause mortality, especially major depressive symptoms (p < .001). The multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for dementia were 1.25 (1.19-1.32) for minor depressive symptoms and 1.42 (1.30-1.54) for major depressive symptoms in comparison to non-depression; p for trend < .001. The multivariable-adjusted HRs and 95% CIs for all-cause mortality were 1.27 (1.21-1.33) for minor depressive symptoms and 1.51 (1.41-1.62) for major depressive symptoms in comparison to non-depression; p for trend < .001. Depression has a stronger impact on dementia and all-cause mortality among the younger group. In addition, dementia significantly mediated the association between depression and all-cause mortality.
Interventions targeting major depression may be an effective strategy for preventing dementia and premature death.
本研究旨在基于日本一项老年人群全国队列研究，探讨抑郁、痴呆与全因死亡率之间的关联和剂量-反应关系。
我们对 2010 年至 2019 年参加日本老年评估研究的 44546 名≥65 岁的参与者进行了一项纵向研究。使用老年抑郁量表-15 评估抑郁症状，使用长期护理保险评估痴呆。使用 Fine-Gray 模型和 Cox 比例风险模型分别探讨抑郁严重程度对痴呆和全因死亡率发生率的影响。使用因果中介分析探讨痴呆介导的抑郁与全因死亡率之间的关联程度。
我们发现，轻度和重度抑郁症状均与痴呆和全因死亡率的累积发生率增加相关，尤其是重度抑郁症状（p<0.001）。与非抑郁相比，轻度抑郁的多变量调整后的风险比（HR）和 95%置信区间（CI）为 1.25（1.19-1.32），重度抑郁为 1.42（1.30-1.54）；趋势检验 p<0.001。与非抑郁相比，轻度抑郁的多变量调整后全因死亡率 HR 和 95%CI 为 1.27（1.21-1.33），重度抑郁为 1.51（1.41-1.62）；趋势检验 p<0.001。抑郁对痴呆和全因死亡率的影响在年轻组中更强。此外，痴呆显著中介了抑郁与全因死亡率之间的关联。
针对重度抑郁的干预措施可能是预防痴呆和过早死亡的有效策略。
