Yao Lulu, Ni Jingnian, Wei Mingqing, Li Ting, Long Ziyi, Shi Jing, Tian Jinzhou
Beijing University of Chinese Medicine, Beijing, China,
Department of Neurology, Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing, China.
Eur Neurol. 2024;87(4):147-158. doi: 10.1159/000540277. Epub 2024 Jul 29.
Depression has been associated with cognitive performance, but whether sociodemographic and clinical characteristics might influence this association is not well elaborated. This study aimed to further explore this relationship in older adults.
This cross-sectional study is based on data from the National Health and Nutrition Examination Survey (NHANES) 2013-2014. A total of 1,433 individuals with complete information on depressive symptoms and cognitive function variables were included in this study. Patient Health Questionnaire 9 (PHQ-9) score ≥10 as the cutoff to identify cases of depression in our study. We defined poor cognitive performance as a composite cognitive score <47. Logistic regression models were used to examine the association of depression with cognitive performance (model 1). We progressively adjusted the covariates as confounders (model 2: model 1 + age, and gender; model 3: model 2 + race, education level, family income, drinking, and smoking; model 4: model 3 + overweight, arthritis, hyperlipidemia, diabetes, hypertension, heart failure, coronary heart disease, heart attack, stroke, and cancer). We then conducted subgroup, interaction, and restricted cubic spline (RCS) analyses to examine this association.
The prevalence of poor cognitive performance was 36.6% (53/145) in the depression group and 14.1% (182/1,288) in the non-depression group. In the fully adjusted model, depression was significantly associated with poor cognitive performance (adjusted odds ratio: 2.25; 95% confidence interval: 1.31-3.81). The results were robust to sensitivity analyses. Gender and education level may modify the association between depression and poor cognitive performance. RCS analysis revealed that the PHQ-9 score was related to poor cognitive performance in a nonlinear manner (p for nonlinearity <0.001), and exhibited a J-shaped curve.
Depression is associated with poor cognitive performance in US older adults. Early recognition and treatment of depression may be potential intervention strategies to protect cognitive health.
抑郁症与认知表现有关，但社会人口统计学和临床特征是否会影响这种关联尚未得到充分阐述。本研究旨在进一步探讨老年人中的这种关系。
这项横断面研究基于2013 - 2014年美国国家健康与营养检查调查（NHANES）的数据。本研究共纳入了1433名具有抑郁症状和认知功能变量完整信息的个体。在我们的研究中，以患者健康问卷9（PHQ - 9）得分≥10作为识别抑郁症病例的临界值。我们将认知表现差定义为综合认知得分<47。使用逻辑回归模型来检验抑郁症与认知表现之间的关联（模型1）。我们逐步调整协变量作为混杂因素（模型2：模型1 + 年龄和性别；模型3：模型2 + 种族、教育水平、家庭收入、饮酒和吸烟；模型4：模型3 + 超重、关节炎、高脂血症、糖尿病、高血压、心力衰竭、冠心病、心脏病发作、中风和癌症）。然后我们进行了亚组分析、交互作用分析和受限立方样条（RCS）分析来检验这种关联。
抑郁症组中认知表现差的患病率为36.6%（53/145），非抑郁症组为14.1%（182/1288）。在完全调整模型中，抑郁症与认知表现差显著相关（调整后的优势比：2.25；95%置信区间：1.31 - 3.81）。结果对敏感性分析具有稳健性。性别和教育水平可能会改变抑郁症与认知表现差之间的关联。RCS分析显示，PHQ - 9得分与认知表现差呈非线性关系（非线性p值<0.001），并呈现出J形曲线。
在美国老年人中，抑郁症与认知表现差有关。早期识别和治疗抑郁症可能是保护认知健康的潜在干预策略。
