Cognitive impairment, depressive symptoms, and functional decline in older people
Cognitive impairment, depressive symptoms, and functional decline in older people
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DOI：
10.1046/j.1532-5415.2002.50259.x
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发表时间：
2002-06-01
影响因子：
6.3
通讯作者：
Covinsky, KE
中科院分区：
文献类型：
--
作者：
Mehta, KM;Yaffe, K;Covinsky, KE
目的：虽然认知障碍和抑郁症状与功能衰退相关，但尚不清楚这些危险因素如何共同影响功能衰退的风险。本研究的目的是确定认知障碍和抑郁症状对老年队列中2年以上日常生活活动（ADL）功能下降的相对贡献。设计：前瞻性队列研究。背景：一项针对老年人的美国国家前瞻性队列研究，《老年人的资产和健康动态》。参与者：从1993年到1995年随访了56,97名参与者（平均年龄77岁，64%女性，86%白人）。测量方法：认知障碍和抑郁症状被定义为得分最低的：在认知量表上低于平均值1.5个标准差或在有效抑郁量表上高于平均值1.5个标准差。与没有危险因素的受试者相比，伴有抑郁症状、认知障碍和两者同时存在的受试者的功能下降风险被计算并按基线依赖性分层。根据人口统计学和合并症对分析进行了调整。结果：8% （n = 450）的受试者ADL功能下降。在基线时独立于所有adl的参与者中，认知障碍参与者2年功能下降的相对风险（RR）为2.3(95%可信区间(CI) = 1.7-3.1)，抑郁症状参与者为1.9 (95% Cl = 1.3-2.6)，认知障碍和抑郁症状参与者为2.4 （95% Cl = 1.4-3.7）。在基线时依赖一种或多种adl的参与者中，认知障碍参与者2年功能衰退的RR为1.9 (95% CI = 1.2-2.8)，抑郁症状参与者为0.6 (95% CI = 0.3-1.3)，认知障碍和抑郁症状参与者为1.5 （95% Cl = 0.8-2.6）。结论：在基线时无ADL依赖的受试者中，认知障碍和抑郁症状是ADL衰退的危险因素，但在基线时ADL依赖的受试者中，认知障碍而非抑郁症状是进一步衰退的危险因素。
OBJECTIVES: Although cognitive impairment and depressive symptoms are associated with functional decline, it is not understood how these risk factors act together to affect the risk of functional decline. The purpose of this study is to determine the relative contributions of cognitive impairment and depressive symptoms on decline in activity of daily living (ADL) function over 2 years in an older cohort.DESIGN: Prospective cohort study.SETTING: A U.S. national prospective cohort study of older people, Asset and Health Dynamics in the Oldest Old.PARTICIPANTS: Five thousand six hundred ninety-seven participants (mean age 77, 64% women, 86% white) followed from 1993 to 1995MEASUREMENTS: Cognitive impairment and depressive symptoms were defined as the poorest scores: 1.5 standard deviations below the mean on a cognitive scale or 1.5 standard deviations above the mean on validated depression scales. Risk of functional decline in participants with depressive symptoms, cognitive impairment, and both, compared with neither risk factor, were calculated and stratified by baseline dependence. Analyses were adjusted for demographics and comorbidity.RESULTS: Eight percent (n = 450) of subjects declined in ADL function. In participants who were independent in all ADLs at baseline, the relative risk (RR) of 2-year functional decline was 2.3 (95% confidence interval (CI) = 1.7-3.1) for participants with cognitive impairment, 1.9 (95% Cl = 1.3-2.6) for participants with depressive symptoms, and 2.4 (95% Cl = 1.4-3.7) for participants with cognitive impairment and depressive symptoms. In participants who were dependent in one or more ADLs at baseline, RR of 2-year functional decline was 1.9 (95% CI = 1.2-2.8) for participants with cognitive impairment, 0.6 (95% CI = 0.3-1.3) for participants with depressive symptoms, and 1.5 (95% Cl = 0.8-2.6) for participants with cognitive impairment and depressive symptoms.CONCLUSIONS: In participants with no ADL dependence at baseline, cognitive impairment and depressive symptoms are risk factors for decline, but that, in participants with dependence in ADL at baseline, cognitive impairment, but not depressive symptoms, is a risk factor for additional decline.