Depression as a modifiable factor to decrease the risk of dementia.
Depression as a modifiable factor to decrease the risk of dementia.
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DOI：
10.1038/tp.2017.90
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发表时间：
2017-05-02
影响因子：
6.8
通讯作者：
Flicker L
中科院分区：
文献类型：
--
作者：
Almeida OP;Hankey GJ;Yeap BB;Golledge J;Flicker L
抑郁症是公认的痴呆症风险因素，但目前尚不清楚这种关系是否存在因果关系。这项研究调查了与抑郁症相关的痴呆症是否随着抗抑郁药的使用而减少，并且与接触抑郁症到痴呆症发作之间的时间无关。我们对4922名年龄在71-89岁、认知健康的男性进行了长达14年的纵向研究，并收集了有关过去抑郁症史、当前抑郁症和抑郁症状严重程度的信息。其他措施包括使用抗抑郁药物、年龄、教育程度、吸烟和糖尿病、高血压、冠心病和中风病史。通过西澳大利亚州数据链接系统确定痴呆的发病和随访期间的死亡。共有682名男性在过去(n=388)或现在(n=294)有抑郁症。随访8.9年，903例(18.3%)发展为痴呆，1884例(38.3%)无痴呆死亡。既往和现在患有抑郁症的男性痴呆的亚危险比(SHR)分别为1.3(95%可信区间=1.0，1.6)和1.5(95%CI=1.2，2.0)。抗抑郁药物的使用并没有降低这种风险。与无症状的男性相比，伴有可疑抑郁症状、轻中度抑郁症状和重度抑郁症状的痴呆患者的SHR分别为1.2(95%CI=1.0、1.4)、1.7(95%CI=1.4、2.2)和2.1(95%CI=1.4、3.2)。抑郁症和痴呆症之间的联系只有在最初5年的随访中才明显。有抑郁症病史的老年男性患痴呆症的风险更高，但抑郁症更有可能是早期痴呆症的标志，而不是真正可改变的风险因素。
Depression is an accepted risk factor for dementia, but it is unclear if this relationship is causal. This study investigated whether dementia associated with depression decreases with antidepressant use and is independent of the time between exposure to depression and the onset of dementia. We completed a 14-year longitudinal study of 4922 cognitively healthy men aged 71–89 years, and collected information about history of past depression, current depression and severity of depressive symptoms. Other measures included use of antidepressants, age, education, smoking and history of diabetes, hypertension, coronary heart disease, and stroke. The onset of dementia and death during follow-up was ascertained via the Western Australian Data Linkage System. A total of 682 men had past (n=388) or current (n=294) depression. During 8.9 years follow-up, 903 (18.3%) developed dementia and 1884 (38.3%) died free of dementia. The sub-hazard ratios (SHRs) of dementia for men with past and current depression were 1.3 (95% confidence interval (CI)=1.0, 1.6) and 1.5 (95% CI=1.2, 2.0). The use of antidepressants did not decrease this risk. Compared to men with no symptoms, the SHRs of dementia associated with questionable, mild-to-moderate and severe depressive symptoms were 1.2 (95% CI=1.0, 1.4), 1.7 (95% CI=1.4, 2.2) and 2.1 (95% CI=1.4, 3.2), respectively. The association between depression and dementia was only apparent during the initial 5 years of follow-up. Older men with history of depression are at increased risk of developing dementia, but depression is more likely to be a marker of incipient dementia than a truly modifiable risk factor.
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