Cognitive decline in patients with dementia as a function of depression.
Cognitive decline in patients with dementia as a function of depression.
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DOI：
10.1097/jgp.0b013e3181e898d0
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发表时间：
2011-04
期刊：
影响因子：
--
通讯作者：
Haroutunian V
中科院分区：
文献类型：
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作者：
Rapp MA;Schnaider-Beeri M;Wysocki M;Guerrero-Berroa E;Grossman HT;Heinz A;Haroutunian V
有证据表明，重度抑郁症会增加患痴呆症的风险，但关于抑郁症是否会加速痴呆症患者的认知能力下降，证据并不一致。作者测试了一种假设，即与没有抑郁史的痴呆症患者相比，患有合并抑郁症的痴呆症患者随着时间的推移认知功能下降更为明显。老龄化的前瞻性纵向队列研究。养老院。养老院住院者313人（基线平均年龄86.99岁，标准差= 6.7；83.1%为女性）。在基线时，有192名居民被诊断患有痴呆症，另有27人在随访期间患上了痴呆症。30名居民在研究期间的任何时候都患有严重抑郁症，48名居民有抑郁症史。作者在长达36个月的时间里使用迷你精神状态检查（MMSE）分数的变化来测量认知能力下降。作者计算了多水平回归模型，以估计年龄、性别、教育程度、痴呆状态、抑郁、抑郁史以及痴呆和抑郁之间的相互作用对MMSE评分随时间变化的影响。除了年龄、性别和受教育程度的影响外，痴呆（β = 13.69，标准误差= 1.38）和抑郁（β = - 4.16, SE = 1.2）的存在使居民的认知能力下降更为急剧，而抑郁和痴呆的存在进一步加速了认知能力下降（β = - 2.72, SE = 0.65）。在痴呆症中，抑郁症的存在对应于超越性别和教育水平的认知能力下降的加速，这表明抑郁症对痴呆症认知能力下降的速度有独特的影响。
There is evidence that major depression increases the risk for dementia, but there is conflicting evidence as to whether depression may accelerate cognitive decline in dementia. The authors tested the hypothesis that decline in cognitive function over time is more pronounced in patients with dementia with comorbid depression, when compared with patients with dementia without depression history. Prospective, longitudinal cohort study of aging. Nursing home. Three hundred thirteen elderly nursing home residents (mean age at baseline: 86.99 years, standard deviation = 6.7; 83.1% women). At baseline, 192 residents were diagnosed with dementia, and another 27 developed dementia during follow-up. Thirty residents suffered from major depression at any point during the study, and 48 residents had a history of depression. The authors measured cognitive decline using change in Mini-Mental State Examination (MMSE) scores over up to 36 months. The authors calculated multilevel regression models to estimate the effects of age, gender, education, dementia status, depression, depression history, and an interaction between dementia and depression, on change in MMSE scores over time. Beyond the effects of age, gender, and education, residents showed steeper cognitive decline in the presence of dementia (β = 13.69, standard error = 1.38) and depression (β = −4.16, SE = 1.2), which was further accelerated by the presence of both depression and dementia (β = −2.72, SE = 0.65). In dementia, the presence of depression corresponds to accelerated cognitive decline beyond gender and level of education, suggesting a unique influence of depression on the rate of cognitive decline in dementia.