Exploring sex differences in the relationship between depressive symptoms and dementia incidence: Prospective results from the PAQUID study
Exploring sex differences in the relationship between depressive symptoms and dementia incidence: Prospective results from the PAQUID study
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DOI：
10.1046/j.1532-5415.2003.51352.x
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发表时间：
2003-08-01
影响因子：
6.3
通讯作者：
Dartigues, JF
中科院分区：
文献类型：
--
作者：
Fuhrer, R;Dufouil, C;Dartigues, JF
目的：在法国老年人的大型前瞻性社区样本中评估抑郁症状与 8 年痴呆发病率之间的预测关系，并比较男性和女性的影响程度。设计：基于前瞻性人群的队列，进行四轮访谈并完成生命状态确定。背景：法国西南部阿基坦地区（吉伦特省和多尔多涅省）的城市和农村社区。参与者：3777 名老年人研究基线时居住在非机构环境中的年龄为 65 岁及以上。 测量：每个参与者都接受神经心理学家的采访，并通过简易精神状态检查、认知测试组和标准化问卷来筛查痴呆症，该问卷旨在根据《精神障碍诊断和统计手册》第三版修订版 (DSM-III-R) 确定是否存在痴呆症标准。痴呆状态和亚型通过神经系统检查确认，并根据 DSM-III-R 痴呆标准和国家神经疾病和中风/阿尔茨海默病及相关疾病协会标准进行分类。计算 Hachinski 评分以明确病因：可能或可能的阿尔茨海默病、血管性痴呆和其他类型的痴呆。使用流行病学研究中心抑郁量表评估抑郁症状。对统计分析进行加权，以纠正非死亡率所致的人员流失。 结果：97 名男性（发病率：14.4/1,000）和 183 名女性（发病率：19.0/1,000）在 8 年的随访期间出现痴呆。男性抑郁症状的基线患病率为 12.9%，女性为 14.7%。抑郁症状会增加后续访谈中患痴呆症的风险，但仅限于男性（比值比 (OR)（男性）= 3.5，95% 置信区间 (CI) = 1.9-6.5；OR（女性）= 1.2，95% CI = 0.7-2.0，性别差异 P 值 = 0.03）。研究了血管抑制可能解释所观察到的性别差异的假设，结果发现患有高血压的男性抑郁的风险比血压正常的男性高 50%。对于女性来说，高血压状况并没有改变相关性的缺失。结论：这项研究支持男性近端抑郁症状与痴呆之间存在关系的假设，但远端抑郁并没有增加该样本中的痴呆风险。结果表明，老年男性的抑郁症可能反映了与脑血管病理学或多发性梗塞疾病相关的一种血管抑郁症，可能会加剧痴呆或衰退过程，从而加速痴呆症明显症状的发作。
OBJECTIVES: To estimate the predictive relationship between depressive symptoms and 8-year dementia incidence in a large prospective community sample of French older adults and to compare the effect magnitude for men and women.DESIGN: Prospective population-based cohort with four interview waves and complete vital status ascertainment.SETTING: Urban and rural communities in the Aquitaine Region (Gironde and Dordogne), southwest France.PARTICIPANTS: Three thousand seven hundred seventy-seven adults aged 65 and older residing in noninstitutional settings at study baseline.MEASUREMENTS: Each participant was interviewed by a neuropsychologist and screened for dementia with the Mini-Mental State Examination, a cognitive test battery, and a standardized questionnaire designed to ascertain the presence of the criteria for dementia according to the Diagnostic and Statistical Manual for Mental Disorders, Third Edition, Revised (DSM-III-R). Dementia status and subtype were confirmed using neurological examination and categorized according to DSM-III-R criteria for dementia and the National Institute of Neurological Disorders and Stroke/Alzheimer's and Related Disorders Association criteria. The Hachinski score was calculated to specify the etiology: possible or probable Alzheimer's disease, vascular dementia, and other types of dementia. Depressive symptomatology was evaluated using the Center for Epidemiologic Studies-Depression scale. Statistical analyses were weighted to correct for attrition not due to mortality.RESULTS: Ninety-seven men (incidence rate: 14.4/1,000) and 183 women (Incidence rate: 19.0/1,000) developed dementia during 8 years of follow-up. Baseline prevalence of depressive symptomatology was 12.9% for men and 14.7% for women. Depressive symptoms increased risk of dementia at subsequent interview wave, but only for men (odds ratio (OR) (men) = 3.5, 95% confidence interval (CI) = 1.9-6.5; OR (women) = 1.2, 95% CI = 0.7-2.0, P -value for sex difference = 0.03). The hypothesis that vascular depression might explain the observed sex difference was studied, and it was found that risk was 50% higher for men with hypertension who were depressed than for normotensive men. For women, hypertension status did not modify the absence of an association.CONCLUSION: This study supports the hypothesis of a relationship between proximal depressive symptomatology and dementia in men, but distant depression did not increase dementia risk in this sample. The results suggest that depression in older men might reflect a form of vascular depression associated with cerebral vascular pathology or multiinfarct disease that may amplify the dementing or declining process, hence accelerating the onset of manifest symptoms of dementia.