Cognitive Sequelae of early and mid-life depression

描述（由申请人提供）：此K23申请将为候选人在晚年精神障碍临床流行病学方面的独立研究生涯做好准备。该研究项目的重点是确定早期和中期抑郁谱系障碍在多大程度上增加了晚年发展为认知缺陷的风险。晚年抑郁与晚年认知缺陷的后续发展有关，但之前没有研究调查过早期和中期抑郁与晚年认知缺陷之间的关系。通过利用最近资助的巴尔的摩流行病学集水区（ECA）研究的第四波，拟议的研究提供了一个不同寻常的、时间敏感的机会来检验这一假设。采用回顾性队列设计，研究者建议选取50岁之前的抑郁症患者作为样本，根据巴尔的摩ECA研究的前几波评估，并在10至23年后检查他们的神经心理结果。该建议的具体目标是：1)确定早期和中期抑郁谱系障碍（50岁之前）是否会增加晚年（60岁以后）发生轻度认知障碍或痴呆的风险；2)调查早期和中期抑郁谱系障碍与晚年特定神经心理领域（即执行功能和记忆）认知缺陷之间的纵向关联；3)估计持续时间、发作次数、早期和中期抑郁谱系障碍的严重程度预示着晚年的认知障碍。这项研究将作为候选人在老年人口流行病学研究的设计和实地工作中获得宝贵经验的工具。为补充其实际研究训练，候选人将同时参加流行病学和老龄化生物统计学的正式课程，并完成硕士学位的要求。他将参加神经心理学博士后项目的研讨会，以发展神经心理学仪器的使用和解释方面的先进知识。一个由导师和顾问组成的小组。Constantine Lyketsos, William Eaton, Jason Brandt, George Rebok, Kung-Yee Liang， George Alexopoulos和Anand Kumar将指导他的研究和培训。该奖项将为他成为晚年精神障碍临床流行病学专家的长期目标奠定基础。

DESCRIPTION (provided by applicant): This K23 application will prepare the candidate for an independent research career in the clinical epidemiology of late-life mental disorders. The focus of the research project is to determine the degree to which early and mid-life depressive spectrum disorder increases risk of developing cognitive deficits in later life. Late-life depression has been associated with subsequent development of cognitive deficits in late life,but no previous study has examined the association between early and mid-life depression and later life cognitive deficits. The proposed study provides an unusual, time-sensitive opportunity to test this hypothesis by taking advantage of the recently funded fourth wave of the Baltimore Epidemiologic Catchment Area (ECA) study. Using a retrospective cohort design, the investigator proposes to sample people with depression before age 50 as assessed in previous waves of the Baltimore ECA studies, and examine their neuropsychological outcomes 10 to 23 years later. The specific aims of the proposal are: 1) to determine whether early and mid-life depressive spectrum disorder (before age 50) increases risk of developing Mild Cognitive Impairment or dementia in later life (after age 60), 2) to investigate the longitudinal association between early and mid-life depressive spectrum disorder and late life cognitive deficits in specific neuropsychological domains (i.e. executive function and memory), and 3) to estimate what extent duration, number of episodes, and severity of early and mid-life depressive spectrum disorder predict cognitive impairment in late life. This study will serve as a vehicle for the candidate to obtain invaluable experience in the design and fieldwork of an epidemiologic study of the aging population. To complement his practical research training, the candidate will concurrently enroll in formal courses in Epidemiology and Biostatistics of Aging and fulfill the requirements for a Master's degree. He will participate in seminars in the post-doctoral program in neuropsychology to develop advanced knowledge in use and interpretation of neuropsychological instruments. A panel of mentors and consultants (Drs. Constantine Lyketsos, William Eaton, Jason Brandt, George Rebok, Kung-Yee Liang, George Alexopoulos, and Anand Kumar) will guide his research and training. This award will provide groundwork for his long term goal of becoming an expert in clinical epidemiology of late life mental disorders.