抑郁与痴呆发生的关联：SHARE 研究的纵向发现。

Association between depression and incident dementia: Longitudinal findings from the share study.

机构信息

Department of Internal Medicine and Geriatrics, Geriatric Unit, University of Palermo, Palermo, Italy.

Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK.

出版信息

Int J Geriatr Psychiatry. 2024 Jul;39(7):e6121. doi: 10.1002/gps.6121.

DOI:10.1002/gps.6121

PMID:38970170

Abstract

BACKGROUND

The association between depression and dementia is still unclear, particularly regarding depression as a potential risk factor preceding dementia. Therefore, we aimed to verify if the presence of depression at baseline may increase the risk of dementia and cognitive impairment during 15 years of follow-up in the SHARE (Survey of Health, Aging and Retirement in Europe) study.

METHODS

Depressive symptoms were defined using the EURO-D, with a score ≥4 indicative of depression. Incident dementia was ascertained using self-reported data and caregivers' information, cognitive impairment using objective cognitive tests. Cox regression analysis, adjusted for 10 baseline confounders, was run and hazard ratios (HRs), with their 95% confidence intervals, were estimated.

RESULTS

In total 22,789 participants were included in the present analysis (mean age 64.2 years) and were predominantly female. The prevalence of depression at baseline was 24.9%. Over 15 years of follow-up, the onset of dementia occurred a median 2 years earlier in people with depression compared to those without. Depression at the baseline significantly increased the risk of dementia in the overall sample (HR = 1.74; 95% CI: 1.54-1.95) and the risk of cognitive impairment (HR = 1.15; 95% CI: 1.06-1.25). For dementia, the association was stronger in people less than 60 years (HR = 2.07; 95% CI: 1.42-3.02) than in participants aged ≥80 years (HR = 1.47; 95% CI: 1.14-1.91). A similar trend was observed for cognitive impairment. Among the single items of the EURO-D, loss of concentration was the strongest individual variable predicting the onset of dementia.

CONCLUSIONS

Depression increased the risk of dementia and cognitive impairment, particularly in younger adults, whereas loss of concentration was the strongest individual predicting variable of dementia. These findings demonstrate the need for early detection of depression for preventing future cognitive worsening.

摘要

背景

抑郁与痴呆之间的关系尚不清楚，尤其是抑郁作为痴呆的潜在风险因素。因此，我们旨在验证在 SHARE（欧洲健康、老龄化和退休调查）研究的 15 年随访中，基线时存在抑郁是否会增加痴呆和认知障碍的风险。

方法

使用 EURO-D 定义抑郁症状，得分≥4 表示抑郁。使用自我报告数据和护理人员信息确定新发痴呆，使用客观认知测试确定认知障碍。进行 Cox 回归分析，调整 10 项基线混杂因素，估计风险比（HR）及其 95%置信区间。

结果

本分析共纳入 22789 名参与者（平均年龄 64.2 岁），以女性为主。基线时的抑郁患病率为 24.9%。在 15 年的随访中，与无抑郁者相比，有抑郁者痴呆的发病时间中位数提前了 2 年。基线时的抑郁显著增加了总体人群发生痴呆的风险（HR=1.74；95%CI：1.54-1.95）和认知障碍的风险（HR=1.15；95%CI：1.06-1.25）。对于痴呆，年龄小于 60 岁的人群的相关性更强（HR=2.07；95%CI：1.42-3.02），而年龄大于等于 80 岁的参与者的相关性较弱（HR=1.47；95%CI：1.14-1.91）。对于认知障碍，也观察到类似的趋势。在 EURO-D 的单项中，注意力不集中是预测痴呆发病的最强个体变量。