Vascular Depression in African Americans: Phenomenology, treatment, and course of

描述（由申请人提供）：血管性抑郁假说提出“脑血管疾病可能诱发、沉淀或延续某些老年抑郁综合征”。非裔美国人（AAs）在美国有最高的血管危险因素，包括高血压，这是世界上最高的。AAs也有较高的缺血性疾病，如心血管疾病、中风和血管性痴呆。事实上，血管性痴呆被认为是老年非裔美国人中“无声的流行病”。提出的研究是基于这样的假设，即由于这些高比例的AAs，血管抑郁的风险也很高。然而，这种关联尚未得到检验，因为尽管美国国立卫生研究院（NIH）的授权已经存在了几十年，但在一般的心理研究和临床试验中，aa的代表性不足。该提案的目标是确定在市中心的公立医院进行心理健康研究的可行性，该医院主要服务于非裔美国人的需求。它建立在Sneed博士和Singh （pi）在过去四年中作为Sneed博士K23奖的一部分而发展起来的社区学术合作伙伴关系的基础上。我们建议1)每年招募20名患有重度抑郁症的AAs（年龄>=50）进行为期一年的研究，包括急性抗抑郁治疗、重复神经心理测试和前后结构MRI；2)在急性治疗期表现出80%的保留率；3)在1年随访中，完成急性治疗期的患者保留率为75%。社区-学术合作，关注高危人群，并结合先进的成像技术代表了血管性抑郁症研究的创新下一步。该可行性研究产生的试点数据将支持随后的R01研究急性治疗反应、复发率、认知障碍进展和血管性抑郁症患者的白质病变负担。此外，该建议符合NIMH的每一个战略目标：1)发展对血管性抑郁症背后的大脑行为过程的综合理解；2)描述发育轨迹，确定何时、何地、如何干预；3)发展社区与学术的伙伴关系；4)满足内城公立医院中服务不足和研究不足的人群的需求；并最终（如果得到资助）促进nimh赞助的研究对公共卫生的影响。

DESCRIPTION (provided by applicant): The vascular depression hypothesis proposes that "cerebrovascular disease may predispose, precipitate, or perpetuate some geriatric depressive syndromes". African Americans (AAs) have among the highest rates of vascular risk factors in the United States, including hypertension, which is among the highest in the world. AAs also have higher rates of ischemia diseases such as cardiovascular disease, stroke, and vascular dementia. Indeed, vascular dementia has been deemed a "silent epidemic" among older adult African Americans. The proposed study is based on the hypothesis that because of these high rates AAs are at high risk for vascular depression. However, this association has yet to be tested as AAs are underrepresented in mental research in general and clinical trials in particular despite mandates from the NIH that have existed for decades. The goal of this proposal is to establish the feasibility of conducting mental health research in an inner-city, public hospital serving the needs of a primarily African American population. It builds on the community-academic partnership Dr. Sneed and Singh (PIs) have developed over the past four years as part of Dr. Sneed's K23 award. We propose to 1) recruit twenty AAs (age >=50) per year with major depression for a one year study involving acute antidepressant treatment, repeat neuropsychological testing, and pre-post structural MRI; 2) demonstrate an 80% retention rate in the acute treatment phase; and 3) demonstrate a 75% retention rate among patients completing the acute treatment phase at 1-year follow-up. The community-academic partnership, focus on a high risk population, and incorporation of advanced imaging techniques represents an innovative next step in the study of vascular depression. The pilot data generated by this feasibility study will support a subsequent R01 examining acute treatment response, relapse rates, and progression of cognitive impairment and white matter lesion burden in AAs with vascular depression. Furthermore, this proposal meets each of NIMH's strategic objectives: 1) develops an integrative understanding of brain- behavior processes underlying vascular depression; 2) characterizes the developmental trajectory to determine when, where, and how to intervene; 3) develops a community- academic partnership; and 4) meets the needs of an underserved and understudied population in an inner city, public hospital setting; and ultimately (if funded), promotes the public health impact of NIMH-sponsored research. PUBLIC HEALTH RELEVANCE: African Americans have the highest rates of hypertension in the world, and not surprisingly, higher rates of cardiovascular disease, stroke, and vascular dementia. Given that the number of African American older adults is expected to increase fivefold by 2050, the social and economic implications of being at high risk for vascular depression could be staggering. Building on a community-academic partnership model, the proposed study addresses this important public health need by establishing the feasibility of conducting mental research in an inner-city, public hospital setting.