Vascular depression: A distinct diagnostic entity?

血管抑制：一个独特的诊断实体？

• 批准号: 7248023
• 负责人: JOEL R. SNEED
• 金额: $ 0.17万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-07-01 至 2007-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7248023
• 关键词: Vascular; depression; distinct; diagnostic; entity

DESCRIPTION (provided by applicant): This is a request for a Mentored Patient-Oriented Research Career Development Award (K23). The training and research components of this proposal provide the applicant with the skills and research settings necessary to test the internal (construct) validity and external (concurrent and predictive) validity of the vascular depression construct. The applicant's career goal is to become an expert in the nosology of late-life neuropsychiatric disorders. The 4-year training plan focuses primarily on the development of expertise in the statistical methods used to carry out thorough psychometric evaluations of diagnostic entities in order to arrive at valid diagnostic criteria. Since diagnostic criteria for late-life disorders may encompass more than phenomenology, secondary training goals are to develop expertise in identifying MRI hyper-intensities and in neuropsychological contributions to the differential diagnosis of depression and dementia. The 4-year research plan complements the training plan by proposing a series of sequential studies that operationalize and test specific diagnostic criteria for vascular depression. The research plan has the following aims: 1. to test the internal (construct) validity of the nosological entity, vascular depression, and determine the diagnostic criteria that most accurately identify its occurrence by applying latent class cluster analysis to three existing late-life depression datasets; 2. To test the external validity of the vascular depression construct by classifying patients from two completed late-life depression treatment trials as vascular depressed or not (non-vascular) according to criteria established in Aim 1, and then comparing the groups with respect to concurrent (phenomenology at baseline) and predictive (short-term treatment response) validity; 3. To test prospectively the external validity of the nosological construct in an 8-week open treatment trial of escitalopram and to determine whether African Americans have a higher than expected rate of vascular depression. In summary, this proposal is the first to attempt a systematic psychometric evaluation of the internal and external validity of the proposed diagnostic category, vascular depression. The strategies applied in this proposal move beyond the use of expert consensus that has dominated previous DSM classification efforts and the diagnostic criteria validated here will likely include MRI and neuropsychological test scores. Thus, vascular depression may serve as a prototype for future diagnostic classifications both in terms of methodology and content; that is, the criteria for vascular depression will likely rely on a combination of phenomenology and laboratory tests in addition to requiring evidence of internal and external validity. This application addresses a major public health concern, the identification and treatment of depression in older adults, the fastest growing segment of the population. It specifically focuses on African American older adults, who have especially high rates of hypertension and may be particularly prone to vascular depression.

描述（由申请人提供）：这是一个指导患者为导向的研究职业发展奖（K23）的请求。本提案的培训和研究部分为申请人提供了必要的技能和研究设置，以测试血管性抑郁症结构的内部（结构）有效性和外部（并发和预测）有效性。申请人的职业目标是成为晚年神经精神障碍疾病分类学的专家。四年期培训计划主要侧重于发展用于对诊断实体进行全面心理测量评估的统计方法方面的专门知识，以达到有效的诊断标准。由于晚年疾病的诊断标准可能不仅仅包括现象学，次要培训目标是发展识别MRI高强度和神经心理学对抑郁症和痴呆症鉴别诊断的贡献的专业知识。这项为期4年的研究计划补充了培训计划，提出了一系列连续的研究，操作和测试血管性抑郁症的具体诊断标准。本研究计划有以下目的：1.测试疾病分类实体血管性抑郁症的内部（结构）有效性，并通过将潜在类别聚类分析应用于三个现有的晚年抑郁症数据集来确定最准确地识别其发生的诊断标准; 2.通过根据目标1中建立的标准将来自两个已完成的晚年抑郁治疗试验的患者分类为血管性抑郁或非血管性抑郁（非血管性），然后比较各组的同时（基线时的现象学）和预测（短期治疗反应）有效性，来测试血管性抑郁结构的外部有效性; 3.在为期8周的艾司西酞普兰开放治疗试验中，前瞻性地测试疾病分类结构的外部有效性，并确定非裔美国人的血管性抑郁发生率是否高于预期。总之，这个建议是第一次尝试一个系统的心理测量评估的内部和外部的有效性的建议的诊断类别，血管性抑郁症。本提案中应用的策略超越了以前主导DSM分类工作的专家共识的使用，此处验证的诊断标准可能包括MRI和神经心理学测试评分。因此，血管性抑郁症可以作为未来诊断分类的方法和内容的原型;也就是说，血管性抑郁症的标准将可能依赖于现象学和实验室检查的组合，除了需要内部和外部有效性的证据。该应用解决了一个主要的公共卫生问题，即老年人抑郁症的识别和治疗，这是人口中增长最快的部分。它特别关注非洲裔美国老年人，他们的高血压发病率特别高，可能特别容易患血管抑郁症。