Late-onset depression: genetic, vascular and clinical contributions
Late-onset depression: genetic, vascular and clinical contributions
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DOI：
10.1017/s0033291701004731
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发表时间：
2001-11-01
影响因子：
6.9
通讯作者：
Wilhelm, K
中科院分区：
文献类型：
--
作者：
Hickie, I;Scott, E;Wilhelm, K
背景资料。神经精神病学研究需要检查病因学、遗传型和临床风险因素与行为表型之间的关系。这些关系现在可以在患有抑郁障碍的老年患者中进行检查。记录78例老年抑郁症患者(平均年龄54(.9)岁，S.D.=14(.)1)和22例健康对照组(平均55(.5)岁，S.D.=9(.6))的主要行为特征、临床和血管危险因素以及可能的迟发性神经退行性疾病和/或血管疾病的基因型别。两种或两种以上血管风险在老年患者(65%对26%的对照组，P<；0(.)01)和晚发性疾病患者(早发性疾病患者，82%对57%，P<；0(.)05)中更常见。晚发性抑郁症患者亚甲基四氢叶酸还原酶(MTHFR)C677T突变纯合子或杂合子的发生率较高(早发性抑郁症患者分别为74%和48%，P<；0.05)。在多变量模型中，只有MTHFR基因突变的存在预测迟发性抑郁症(优势比=3(.)8，95%CI=1(.)1-12(.)9)。载脂蛋白E epsilon 4或epsilon 2均与抑郁、迟发性抑郁、认知障碍或精神运动改变无关。有载脂蛋白E epsilon 4的患者不太可能有精神病形式的抑郁。晚发性抑郁症患者存在C677T亚甲基四氢叶酸还原酶基因突变及其他血管危险因素的增加。这表明，这些患者中的一部分可能有基因决定的和/或其他血管病因。有这些疾病风险的患者可以通过目前可用的预防策略得到帮助。
Background. Neuropsychiatric research needs to examine the relationships between aetiological, genotypic and clinical risk factors and behavioural phenotypes. These relationships can now be examined in older patients with depressive disorders.Methods. Key behavioural features, clinical and vascular risk factors and putative genotypes for late-onset neurodegenerative disorders and/or vascular disease were recorded in 78 older patients with depression (mean age = 54(.)9 years, S.D. = 14(.)1) and 22 healthy control subjects (mean age 55(.)5 years, S.D. = 9(.)6).Results. Two or more vascular risks were more common in older patients (65 % v. 26 % of control subjects, P < 0(.)01), and in patients with late-onset disorders (82 % v. 57 % in patients with early-onset disorders, P < 0(.)05). Patients with late-onset depression had a higher prevalence of the homozygous or heterozygous forms of the C677T mutation of the methylenetetrahydrofolate reductase enzyme (MTHFR)(74 % v. 48 % in patients with early-onset disorders, P < 0(.)05). In a multivariate model, only presence of the MTHFR gene mutation predicted late-onset depression (odds ratio = 3(.)8, 95 % CI = 1(.)1-12(.)9). Neither apolipoprotein E epsilon 4 or epsilon 2 was associated with depression, late-onset depression, cognitive impairment, or psychomotor change. Patients with apolipoprotein E epsilon 4 were less likely to have psychotic forms of depression.Conclusions. Patients with late-onset depression had an increased rate of the C677T MTHFR gene mutation and other vascular risk factors. This suggests that a proportion of these patients may have genetically-determined and/or other vascular aetiologies. Patients at risk of these disorders may be assisted by currently-available preventative strategies.