Long Term Depressive Symptom Course & Adverse Health Outcomes among Older Women

描述(申请人提供)：抑郁症状在老年人中非常常见，特别是在女性中，并与认知和身体残疾有关，尽管这种联系的性质和方向，包括因果解释，仍然存在争议。我们建议调查老年女性的抑郁症状与认知能力之间的关系。 以及长期的功能衰退。仅在一个时间点评估抑郁症状 (在几乎所有以前的研究中都是这样)是不够的，因为抑郁症状通常随着时间的推移而变化，而且抑郁症状的累积影响可能需要时间来表现出来。为了更好地调查抑郁症等慢性疾病的全部影响，我们需要研究其长期进程，以符合2008年NIMH战略计划，以绘制精神健康症状的轨迹，并与PA-07-163中所述的研究优先事项相一致。我们还建议调查几个有针对性的生物学机制，这些机制可能是抑郁症状与认知和功能下降之间联系的基础。很少有研究对这些机制进行全面研究，然而，它们的发现可能为预防和治疗带来重要机会，更不用说对抑郁症生物学的基本理解了。 最后，我们建议研究抑郁症状对高龄老人的影响。关于这一人群中抑郁症状的患病率和严重程度及其相关的健康后果的信息很少，通常被定义为85岁的老年人，也是美国人口中增长最快的部分。根据我们的初步数据，严重的抑郁症状在这一人群中很常见，影响到15%-25%的高龄老年人。我们的目标将通过正在进行的对10,000多名老年妇女(包括3800名年龄最大的老年妇女)的前瞻性研究来实现，她们在65岁时登记，并已被严格跟踪近20年。以极具成本效益的方式，我们 将决定抑郁症状的长期病程，以及这些症状与认知和功能衰退的发展是如何关联的。此外，我们将确定抑郁症状和这些结果之间的关联是否部分由关键的生物学途径解释，如炎症、睡眠质量、心血管疾病和血液淀粉样蛋白水平。从这项提议中获得的知识对于理解抑郁症状长期对老年妇女(包括年龄最大的老年人)健康结果的影响将是新的和关键的。它将对监测/治疗患有抑郁症状的老年人的临床需求以及可能将抑郁与认知障碍和残疾联系起来的生物机制提供重要的见解。 公共卫生相关性：从这项提议中获得的知识对于了解老年抑郁症状对老年妇女(包括年龄最大的老年人)与年龄相关的健康结果的影响将是新的和关键的。它将对监测/治疗患有抑郁症状的老年人的临床需求以及可能将抑郁与认知和功能下降联系起来的生物学机制提供重要的见解。

DESCRIPTION (provided by applicant): Depressive symptoms are very common in the elderly, especially among women, and have been linked with cognitive and physical disability, although the nature and direction of this association, including the causal interpretation, remains controversial. We propose to investigate how depressive symptoms among elderly women are associated with cognitive and functional decline over the long term. Assessing depressive symptoms at only one timepoint (as has been done in almost all previous studies) is inadequate because depressive symptoms are commonly variable over time, and because the cumulative impact of depressive symptoms may take time to manifest itself. To best investigate the full impact of a chronic disease such as depression, we need to study its long-term course, in accord with the 2008 NIMH Strategic Plan to chart trajectories of mental health symptoms and with research priorities expressed in PA-07-163. We also propose to investigate several targeted biological mechanisms that may underlie the association between depressive symptoms and cognitive and functional decline. Few studies, if any, have comprehensively investigated these mechanisms and yet, their discovery could yield important opportunities for prevention and treatment, not to mention an essential understanding of the biology of depression. Finally we propose to study the effects of depressive symptoms in the oldest old. Little information exists on the prevalence and severity of depressive symptoms and their associated health outcomes in this population, typically defined as elders aged =85 years, and the fastest growing segment of the U.S. population. Based on our preliminary data, substantial depressive symptoms are common in this population, affecting 15-25% of the oldest old. Our aims will be addressed from ongoing prospective study of over 10,000 elderly women (including 3800 oldest old) who enrolled at age = 65 years and who have been rigorously followed for almost 20 years. In an extremely cost-effective approach, we will determine the long-term course of depressive symptoms and how these symptoms are associated with the development of cognitive and functional decline. In addition, we will determine if the association between depressive symptoms and these outcomes is partially explained by key biological pathways such as inflammation, sleep quality, cardiovascular disease and blood ¿-amyloid level. Knowledge gained from this proposal will be both novel and critical for understanding the impact of depressive symptoms over the long term on health outcomes in older women including the oldest old. It will shed important insights on both the clinical need for monitoring/treating the elderly with depressive symptoms and on the biological mechanisms that may link depression to cognitive impairment and disability. PUBLIC HEALTH RELEVANCE: Knowledge gained from this proposal will be both novel and critical for understanding the impact of geriatric depressive symptoms on age-related health outcomes in older women including the oldest old. It will shed important insights on both the clinical need for monitoring/treating the elderly with depressive symptoms and on the biological mechanisms that may link depression to cognitive and functional decline.