Vascular depression: A distinct diagnostic entity?

描述(由申请者提供)：这是一个以患者为导向的研究事业发展奖(K23)的申请。本提案的培训和研究部分为申请者提供了必要的技能和研究环境，以测试血管抑郁结构的内部(构建)有效性和外部(同时和预测)有效性。申请者的职业目标是成为晚年神经精神障碍的病因学专家。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门知识，以便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。由于晚年生活障碍的诊断标准可能不仅仅包括现象学，因此次要培训目标是开发识别MRI高强度信号的专业知识，并在神经心理学方面对抑郁症和痴呆症的鉴别诊断做出贡献。为期4年的研究计划通过提出一系列连续研究来补充培训计划，这些研究可操作并测试血管性抑郁症的特定诊断标准。研究计划有以下目标：1.测试病因学实体--血管性抑郁症的内部(结构)效度，并通过对现有的三个老年抑郁症数据集应用潜在类聚类分析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中建立的标准将两个已完成的老年抑郁症治疗试验中的患者分类为血管性抑郁症或非血管性抑郁症(非血管性抑郁症)，然后比较两组的并发(基线的现象学)和预测性(短期治疗反应)有效性，来测试血管性抑郁症的外部效度；3.在一项为期8周的艾司西普兰开放治疗试验中，前瞻性地测试病因学结构的外部有效性，并确定非裔美国人是否有比预期更高的血管抑郁发生率。总之，这项建议是第一次尝试对拟议的诊断类别--血管性抑郁症--的内部和外部有效性进行系统的心理测量学评估。这项建议中应用的策略超越了专家共识的使用，这种共识主导了以前的DSM分类工作，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，血管性抑郁症可能在方法和内容方面作为未来诊断分类的原型；也就是说，血管性抑郁症的标准除了需要内部和外部有效性的证据外，还可能依赖于现象学和实验室测试的组合。这一应用解决了一个主要的公共卫生问题，即识别和治疗老年人的抑郁症，这是人口增长最快的部分。它特别关注非裔美国老年人，他们高血压的发病率特别高，可能特别容易患上血管抑郁症。

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.