Depressive symptoms exacerbate disability in older adults: A prospective cohort analysis of participants in the MemAID trial.
Depressive symptoms exacerbate disability in older adults: A prospective cohort analysis of participants in the MemAID trial.
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DOI：
10.1371/journal.pone.0278319
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发表时间：
2022
期刊：
影响因子：
3.7
通讯作者：
中科院分区：
文献类型：
--
作者：
老年人保持独立是生活质量的一个重要方面。我们调查了抑郁症状作为一个重要的可改变的危险因素，可能介导的身体和认知能力下降对残疾的影响。我们前瞻性分析了223名成年人（年龄50-85岁; 117名对照组和106名2型糖尿病患者）48周的数据，他们参加了一项临床试验“2型糖尿病鼻内胰岛素记忆促进”。从基线、第25周和第48周访视时获得自报残疾（世界卫生组织残疾评估表）和抑郁症状（老年抑郁量表）的数据。在基线时评估认知（简易精神状态检查）和医学合并症（Charlson合并症指数）。纵向分析评估了抑郁症状的变化预测残疾恶化的程度。进行中介分析，以确定抑郁症状在多大程度上导致与认知能力差、步行速度和合并症相关的残疾。基线时，抑郁症状、认知和步行速度均在正常范围内，但参与者10年心血管死亡风险较高。抑郁症状与基线（p<0.001）和纵向（p<0.001）残疾相关。认知、步行速度和合并症与基线残疾相关（p值= 0.027-0.001）。抑郁症状对残疾纵向有很大的介导作用：通过抑郁对残疾的间接影响占认知影响的51%，流动性影响的34%和合并症影响的24%。抑郁症状实质上加重了认知、步态速度和合并症对残疾的影响。在我们的样本中，大多数人的得分在老年抑郁量表的“正常”范围内，这表明即使是亚临床症状也可能导致残疾。治疗亚临床抑郁症，这可能是认识不足的老年人，应该是一个公共卫生的优先事项，以帮助保持独立与老化。
Maintaining independence in older age is an important aspect of quality of life. We investigated depressive symptoms as an important modifiable risk factor that may mediate the effects of physical and cognitive decline on disability. We prospectively analyzed data from 223 adults (age 50–85; 117 controls and 106 with type-2 diabetes) over 48 weeks who were participating in a clinical trial “Memory Advancement by Intranasal Insulin in Type 2 Diabetes.” Data from self-reported disability (World Health Organization Disability Assessment Schedule) and depressive symptoms (Geriatric Depression Scale) were obtained from baseline, week 25, and week 48 visits. Cognition (Mini-mental status examination) and medical comorbidities (Charlson Comorbidity Index) were assessed at baseline. Longitudinal analysis assessed the extent to which change in depressive symptoms predicted worsening disability. Mediation analyses were performed to determine the extent to which depressive symptoms accounted for disability associated with worse cognition, walking speed, and comorbidities. At baseline, depressive symptoms, cognition, and walking speed were within normal limits, but participants had a high 10-year risk of cardiovascular mortality. Depressive symptoms were related to disability at baseline (p<0.001), and longitudinally (p<0.001). Cognition, walking speed, and comorbidities were associated with disability at baseline (p-values = 0.027–0.001). Depressive symptoms had a large mediating effect on disability longitudinally: the indirect effect on disability via depression accounts for 51% of the effect of cognition, 34% of the effect of mobility, and 24% of the effect of comorbidities. Depressive symptoms substantially exacerbated the effects of worsening cognition, gait speed, and comorbidities on disability. In our sample, most individuals scored within the “normal” range of the Geriatric Depression Scale, suggesting that even subclinical symptoms can lead to disability. Treating subclinical depression, which may be under-recognized in older adults, should be a public health priority to help preserve independence with aging.
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影响因子：
3.4
作者：
Morin, Ruth T.;Nelson, Craig;Bickford, David;Insel, Philip S.;Mackin, R. Scott
通讯作者：
Mackin, R. Scott
影响因子：
17.7
作者：
Druss, BG;Marcus, SC;Pincus, HA
通讯作者：
Pincus, HA
影响因子：
2.2
作者：
Galindo-Mendez, B.;Trevino, J. A.;Novak, V
通讯作者：
Novak, V
影响因子：
7.2
作者：
Mackin, R. Scott;Nelson, J. Craig;Delucchi, Kevin;Raue, Patrick;Byers, Amy;Barnes, Deborah;Satre, Derek D.;Yaffe, Kristine;Alexopoulos, George S.;Arean, Patricia A.
通讯作者：
Arean, Patricia A.
影响因子：
13.1
作者：
Anton SD;Woods AJ;Ashizawa T;Barb D;Buford TW;Carter CS;Clark DJ;Cohen RA;Corbett DB;Cruz-Almeida Y;Dotson V;Ebner N;Efron PA;Fillingim RB;Foster TC;Gundermann DM;Joseph AM;Karabetian C;Leeuwenburgh C;Manini TM;Marsiske M;Mankowski RT;Mutchie HL;Perri MG;Ranka S;Rashidi P;Sandesara B;Scarpace PJ;Sibille KT;Solberg LM;Someya S;Uphold C;Wohlgemuth S;Wu SS;Pahor M
通讯作者：
Pahor M