Dysthymia and depression increase risk of dementia and mortality among older veterans.
Dysthymia and depression increase risk of dementia and mortality among older veterans.
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DOI：
10.1097/jgp.0b013e31822001c1
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发表时间：
2012-08
期刊：
影响因子：
--
通讯作者：
Yaffe K
中科院分区：
文献类型：
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作者：
Byers AL;Covinsky KE;Barnes DE;Yaffe K
确定在“真实的世界”中，不太严重的抑郁症谱诊断（如心境恶劣）以及抑郁症是否与发展为痴呆症的风险和死亡率相关。使用退伍军人事务部（VA）国家患者护理数据库（1997-2007）进行的回顾性队列研究。在美国的医疗中心。在研究基线（1997-2000年），共有281，540名55岁及以上的退伍军人没有痴呆症。在研究基线（1997-2000年）和随访（2001-2007年）期间，分别根据ICD-9编码确定抑郁状态和痴呆事件。通过VA生命状态文件中的死亡日期确定死亡率。10%的退伍军人有抑郁症的基线诊断，近1%有心境恶劣。未校正的痴呆发生率在抑郁症退伍军人中为11.2%，在恶劣心境中为10.2%，在两者都没有的退伍军人中为6.4%。在调整人口统计学和合并症后，诊断为恶劣心境或抑郁症的患者发生痴呆的可能性是无恶劣心境/抑郁症患者的两倍（调整后的恶劣心境风险比[HR]：1.96，95%置信区间[CI]：1.71-2.25;抑郁症HR：2.18，95% CI：2.08-2.28）。心境恶劣和抑郁症也与死亡风险增加相关（31.6%的心境恶劣和32.9%的抑郁症与28.5%的两者均不相关;校正后的心境恶劣HR：1.41，95% CI：1.31-1.53;抑郁HR：1.47，95% CI：1.43-1.51）。研究结果表明，患有心境恶劣或抑郁症的老年人需要密切监测不良后果。未来的研究应该确定抑郁谱系障碍的治疗是否可以降低这些结果的风险。
To determine if less severe depression spectrum diagnoses such as dysthymia, as well as depression, are associated with risk of developing dementia and mortality in a “real world” setting. Retrospective cohort study conducted using the Department of Veterans Affairs (VA) National Patient Care Database (1997-2007). VA medical centers in the United States. A total of 281,540 veterans 55 years and older without dementia at study baseline (1997-2000). Depression status and incident dementia were ascertained from ICD-9 codes during study baseline (1997-2000) and follow-up (2001-2007), respectively. Mortality was ascertained by time of death dates in the VA Vital Status File. Ten percent of veterans had baseline diagnosis of depression and nearly 1% had dysthymia. The unadjusted incidence of dementia was 11.2% in veterans with depression, 10.2% with dysthymia and 6.4% with neither. After adjusting for demographics and comorbidities, patients diagnosed with dysthymia or depression were twice as likely to develop incident dementia compared to those with no dysthymia/depression (adjusted dysthymia hazard ratio [HR]: 1.96, 95% confidence interval [CI]: 1.71-2.25; and depression HR: 2.18, 95% CI: 2.08-2.28). Dysthymia and depression also were associated with increased risk of death (31.6% dysthymia and 32.9% depression vs 28.5% neither; adjusted dysthymia HR: 1.41, 95% CI: 1.31-1.53; and depression HR: 1.47, 95% CI: 1.43-1.51). Findings suggest that older adults with dysthymia or depression need to be monitored closely for adverse outcomes. Future studies should determine whether treatment of depression spectrum disorders may reduce risk of these outcomes.