Vascular depression: A distinct diagnostic entity?

描述（由申请人提供）：这是一份指导患者导向研究职业发展奖（K23）的申请。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，以测试血管抑郁构建的内部（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一名老年神经精神疾病分类学专家。这项为期4年的培训计划主要侧重于发展统计方法方面的专业知识，这些方法用于对诊断实体进行彻底的心理测量评估，以得出有效的诊断标准。由于老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高强度的专业知识以及对抑郁症和痴呆症鉴别诊断的神经心理学贡献。这项为期4年的研究计划通过提出一系列连续的研究来补充培训计划，这些研究将对血管性抑郁症的具体诊断标准进行操作和测试。研究计划有以下目的：通过对三个现有的老年抑郁症数据集进行潜在类聚类分析，检验血管性抑郁症这一疾病分类学实体的内部（结构）有效性，并确定最准确识别其发生的诊断标准；2. 为了检验血管性抑郁结构的外部效度，根据Aim 1中建立的标准，将两项已完成的晚期抑郁症治疗试验中的患者分为血管性抑郁或非血管性抑郁（非血管性），然后比较两组的并发效度（基线现象学）和预测效度（短期治疗反应）；3. 在一项为期8周的艾司西酞普兰开放治疗试验中，前瞻性地检验该病分学结构的外部有效性，并确定非裔美国人的血管性抑郁症发生率是否高于预期。总之，这一建议是第一个尝试系统的心理测量评估提出的诊断类别，血管抑郁的内部和外部有效性。本提案中应用的策略超越了以前DSM分类工作中占主导地位的专家共识的使用，并且这里验证的诊断标准可能包括MRI和神经心理学测试分数。因此，血管抑郁可以作为未来诊断分类方法和内容的原型；也就是说，除了需要内部和外部有效性的证据外，血管抑郁的标准可能依赖于现象学和实验室测试的结合。该应用程序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，老年人是人口中增长最快的部分。它特别关注非裔美国老年人，他们的高血压发病率特别高，可能特别容易患血管性抑郁症。

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.