Is subclinical thyroid dysfunction in the elderly associated with depression or cognitive dysfunction?
Is subclinical thyroid dysfunction in the elderly associated with depression or cognitive dysfunction?
复制标题
DOI：
10.7326/0003-4819-145-8-200610170-00006
复制
发表时间：
2006-10-17
影响因子：
39.2
通讯作者：
Parle, James V.
中科院分区：
文献类型：
--
作者：
Roberts, Lesley M.;Pattison, Helen;Parle, James V.
背景资料：甲状腺激素和促甲状腺激素（TSH）的自动化灵敏测定的广泛使用增加了对轻度甲状腺功能障碍的识别，特别是在老年患者中。这种功能障碍的临床意义，但是，仍然不确定，与认知功能障碍，抑郁症和焦虑的协会是unconfirmed.Objective：要确定轻度甲状腺功能障碍和认知，抑郁症和焦虑症之间的关联在老年人。设计：横断面研究。通过混合模型分析探讨了相关性。设置：英格兰中部的初级保健实践。患者：5865例65岁或65岁以上的患者，他们没有已知的甲状腺疾病，从初级保健registrations.Measurements招募：血清TSH和游离甲状腺素（T-4）进行了测量。采用医院焦虑和抑郁量表（HADS）评估抑郁和焦虑，采用米德尔塞克斯老年精神状态评估和Folstein简易精神状态检查建立认知功能。共病条件，药物使用，和社会人口学profiles.Results：295例患者符合亚临床甲状腺功能障碍的标准（127甲状腺功能亢进，168甲状腺功能减退）。在控制混杂变量后，焦虑（HADS评分）与TSH水平（P = 0.013）之间以及认知与TSH和游离T-4水平之间存在统计学显著相关性。这些关联的程度缺乏临床相关性：TSH水平增加50 mIU/L与HADS焦虑评分降低1分相关，简易精神状态检查评分增加1分与TSH水平增加50 mIU/L或游离T-4水平增加25 pmol/L相关。局限性：由于参与率低，亚临床甲状腺功能障碍的患病率低，以及其他未确定的招募偏倚，参与者可能不代表老年人群。在控制了共病和药物使用的混杂效应后，亚临床甲状腺功能障碍与抑郁、焦虑或认知无关。
Background: Widespread use of automated sensitive assays for thyroid hormones and thyroid-stimulating hormone (TSH) has increased identification of mild thyroid dysfunction, especially in elderly patents. The clinical significance of this dysfunction, however, remains uncertain, and associations with cognitive impairment, depression, and anxiety are unconfirmed.Objective: To determine the association between mild thyroid dysfunction and cognition, depression, and anxiety in elderly persons.Design: Cross-sectional study. Associations were explored through mixed-model analyses.Setting: Primary care practices in central England.Patients: 5865 patients 65 years of age or older with no known thyroid disease who were recruited from primary care registers.Measurements: Serum TSH and free thyroxine (T-4) were measured. Depression and anxiety were assessed by using the Hospital Anxiety and Depression Scale (HADS), and cognitive functioning was established by using the Middlesex Elderly Assessment of Mental State and the Folstein Mini-Mental State Examination. Comorbid conditions, medication use, and sociodemographic profiles were recorded.Results: 295 patients met the criteria for subclinical thyroid dysfunction (127 were hyperthyroid, and 168 were hypothyroid). After confounding variables were controlled for, statistically significant associations were seen between anxiety (HADS score) and TSH level (P = 0.013) and between cognition and both TSH and free T-4 levels. The magnitude of these associations lacked clinical relevance: A 50-mlU/L increase in the TSH level was associated with a 1-point reduction in the HADS anxiety score, and a 1-point increase in the Mini-Mental State Examination score was associated with an increase of 50 mlU/L in the TSH level or 25 pmol/L in the free T-4 level.Limitations: Because of the low participation rate, low prevalence of subclinical thyroid dysfunction, and other unidentified recruitment biases, participants may not be representative of the elderly population.Conclusions: After the confounding effects of comorbid conditions and use of medication were controlled for, subclinical thyroid dysfunction was not associated with depression, anxiety, or cognition.